Mussel-inspired antibacterial polydopamine/chitosan/temperature-responsive hydrogels for rapid hemostasis.

The aim of this study was to develop an effective wound dressing using a temperature-responsive hydroxybutyl chitosan (HBC) based hydrogel. The HBC - chitosan (CS) - dopamine (HCS-DOPA) composite hydrogels were prepared by the dopamine self-polymerization at different concentrations (0, 0.5, 1.0 and 2.0 mg/mL), termed as HCS, HCS-DOPA-0.5, HCS-DOPA-1 and HCS-DOPA-2, respectively. The gelling characteristic of HBC hydrogel was not influenced by composite CS and DOPA. The HCS-DOPA composite hydrogels were non-cytotoxic to mouse fibroblast cells (L929), and induced under 5.0% hemolysis rate. In vitro antibacterial studies, composite HCS-DOPA-2 hydrogels exhibited lasting inhibition to S. aureus >8 h. The whole blood test in vitro demonstrated that blood clotting time treated with HCS-DOPA-2 composite hydrogels was shortened to 95.6 s compared with that of HCS in vitro hemostasis. The results suggested that HCS-DOPA-2 composite hydrogels could be applied as a promising wound dressing for hemostasis in vitro.

Study of the association between hemorrhage and the position of hemorrhagic stigmata in patients with esophageal varices.

The aim of the present study was to investigate the predilection position of hemorrhagic stigmata (HS) in patients with esophageal variceal hemorrhage and provide guidance on endoscopic therapy for esophageal varices. The clinical characteristics, particularly the endoscopic manifestations of HS, in the patients who presented with gastroesophageal variceal hemorrhage and cirrhosis between January 2003 and December 2013 at our hospital were summarized and patients were grouped according to the distance of the lesion site to incisors at 35-40 and ~30 cm. The association between the location of HS and active hemorrhage was assessed. The location of hemorrhage and HS at 35-40 cm from the incisors was more common in esophageal varices patients, followed by the location at ~30 cm from the incisors (P<0.0001). The incidence of HS in esophageal varices patients in the 35-40 cm group was significantly higher than that in the ~30 cm group except for HS at 9:00 position (P<0.0001). The highest incidence of HS in the ~30 cm group was at the 3:00 position, followed by the 12:00, 6:00 and 9:00 position. Among them, there were significant differences between the 3:00 and 6:00 position, the 3:00 and 9:00 position, and the 9:00 and 12:00 position (P<0.05). The order in the 35-40 cm group was similar to that in the ~30 cm group and the incidence of HS at the 9:00 position was lowest (P<0.05). A certain association between the point of location of HS and hemorrhage was identified. HS located at 35-40 cm from the lesion site to incisors was identified to be most likely to bleed, followed by that located at ~30 cm. In addition, the incidence of HS at 9:00 position was found to be lower than that in the other positions. Therefore, HS located at ~30 cm and 35-40 cm from the lesion site to incisors should be paid attention to and the 3:00, 12:00 and 6:00 rather than the 9:00 position should be prioritized during endoscopic treatment, particularly in emergency situations.

Reasons and risk factors for irregular-interval endoscopic variceal sclerotherapy in patients with esophageal variceal bleeding.

OBJECTIVE: Endoscopic variceal sclerotherapy (EVS) is usually carried out at weekly intervals in patients with esophageal variceal bleeding (EVB). However, some patients receive sclerotherapy at irregular intervals. In this study we aimed to elucidate the reasons and risk factors for irregular-interval sclerotherapy in patients with EVB, and to evaluate the safety and efficacy of interrupted irregular intervals in these patients. METHODS: Medical records of patients who were admitted to the Chinese PLA General Hospital from December 2013 to June 2015 for EVS were retrospectively analyzed. EVS sessions were scheduled to be repeated at regular weekly intervals. However, some of these patients received at least one treatment session at irregular intervals (mainly <7 days). This irregular-interval group was further divided into those whose treatment was rescheduled for emergency and elective reasons. RESULTS: Irregular treatment intervals were mainly caused by early rebleeding, initial emergency treatment, and holidays. However, there were no differences in the rates of complication and variceal eradication between patients treated at weekly and irregular intervals. Multivariate logistic regression analysis identified ascites (P = 0.0009), variceal erosion (P = 0.0003), and maximum injected volume of sclerosing agent per session (P = 0.0008) to be associated with emergency irregular-interval treatment. Only age differed between the elective irregular-treatment and weekly treatment groups. CONCLUSIONS: Early rebleeding, initial emergency treatment, and treatment over holidays may necessitate irregular sclerotherapy intervals in patients with EVB. Moreover, ascites, variceal erosion, and maximum injected volume of sclerosing agent per session are risk factors for emergency sclerotherapy, whereas elective adjustments to treatment schedules as a result of holidays do not affect the outcomes of patients undergoing EVS for EVB.

Increased FAT10 expression is related to poor prognosis in pancreatic ductal adenocarcinoma.

It has been reported that FAT10 plays an important role in cell proliferation. Their activity is increased in malignant cells compared to benign cells. However, the clinical and functional significance of FAT10 expression has not been characterized previously in pancreatic ductal adenocarcinoma (PDAC). The purpose of this study was to assess FAT10 expression and to explore its contribution to PDAC. Real-time quantitative PCR was performed to examine FAT10 expression in 38 pairs of fresh frozen PDAC tissues and corresponding noncancerous tissues. Using immunohistochemistry, we performed a retrospective study of the FAT10 expression levels on 134 archival PDAC paraffin-embedded samples. The relationship between FAT10 mRNA expression and clinicopathological features was analyzed by appropriate statistics. Kaplan-Meier analysis and Cox proportional hazards regression models were used to investigate the correlation between FAT10 expression and prognosis of PDAC patients. The relative mRNA expression of FAT10 was significantly higher in PDAC tissues than in adjacent noncancerous tissues (P<0.001). By immunohistochemistry, the data revealed that high FAT10 expression was significantly correlated with clinical stage (P<0.001), histological differentiation (P=0.004), and lymph node metastasis (P=0.013). Consistent with these results, we found that high expression of FAT10 was significantly correlated with poor survival in PDAC patients (P<0.001). Furthermore, Cox regression analyses showed that FAT10 expression was an independent predictor of overall survival. In conclusion, this study confirmed the overexpression of FAT10 and its association with tumor progression in PDAC. It also provided the first evidence that FAT10 expression in PDAC was an independent prognostic factor of patients, which might be a potential diagnostic and therapeutic target of PDAC.

[A retrospective analysis of ectopic varices in gastrointestinal tract diagnosed by endoscopy].

OBJECTIVE: To understand the incidence, causes, clinical manifestations and treatment of ectopic varices (EV) in gastrointestinal (GI) tract. METHODS: GI endoscopic examinations were carried out in 99 783 patients from January 2004 to October 2012 in General Hospital of PLA. Sixty-four cases of ectopic varices in GI tract were discovered. The clinical manifestations of EV patients and treatment were analyzed retrospectively. The literatures of EV were reviewed. RESULTS: The prevalence of EV in GI was 0.06% (64/99 783) in all patients undergoing endoscopic examinations, including 5 in the gastric antrum, 37 in the duodenum, 2 in the colon, 17 in the rectum, 1 in terminal ileum as well as whole colorectum, and 2 in the anastomotic stomas. The causes of EV included portal hypertension with cirrhosis in 52 cases (42 of hepatitis as dominant, 5 of alcoholic, 3 of biliary). Twenty-five cases had past history of endoscopic sclerotherapy, tissue adhesive injection or band ligation.Extrahepatic portal vein obstruction was seen in 4 cases (1 with pancreatic cancer, gastric cardia after surgery, pancreatic cancer after surgery, small intestine after partial hepatectomy respectively) and 8 cases uncertain. Nine cases accepted endoscopic tissue adhesive injection (no post-operative hemorrhage occurred in 9 cases and EV disappeared in 3 cases). Endoscopic band ligation was performed only for one patient. CONCLUSIONS: EV in GI tract is a rare condition, which occurs commonly in duodenum, colon, and rectum. Portal hypertension is the most common cause. Gastrointestinal hemorrhage is the main clinical manifestation. EV should be considered in GI bleeding, with gastroesophageal varices hemorrhage excluded. Endoscopic adhesive injection is an effective way to treat EV.

[Combined transgastric and transcolonic endoscopic salpingectomy: experiment with pigs].

OBJECTIVE: To compare the feasibility and safety of combined transgastric and transcolonic dual approach and those of transgastric single approach in endoscopic salpingectomy. METHODS: Two female Chinese Nongda miniature pigs underwent gastric and colonic lavage with tap water followed by disinfection of mucosa with 1:10 iodophor. An endoscope was inserted and the colonic wall was punctured with a needle knife, dilated with a balloon-dilator and a double-channel endoscope was advanced into the peritoneal cavity. Under direct observation through this endoscope, a trans-gastric entrance was made with the second double-channel endoscope. With the help of transcolonic endoscope, the left Fallopian tube was ligated and partially resected using the transgastric endoscope. With the help of transgastric endoscope, liver biopsy was performed using the transcolonic endoscope. Finally, the gastric incision was closed with 3 clips and the colonic incision was closed with a loop and a clip. Antibiotics were used for 3 days following the procedures. Seventeen days later laparotomy was performed to observe the infection, visceral damage and adhesion, healing of the incisions of gastrointestinal duct, etc. RESULTS: Compared with the single route, the dual routes were more convenient to perform the liver biopsy and salpingectomy. The pigs drank and ate normally soon after the resuscitation. The pigs looked well and gained weight during 2 weeks after the operation. Repeat endoscopy in 2 weeks showed a well-healed gastric incision with 2 clips still in place and a healed colonic incision with 1 clip still attached. The necropsy revealed a complete transmural healing of the gastric incision with minimal adhesion and a complete healing of the colonic incision without any adhesion. Few adhesions were found around the liver biopsy site and the salpingectomy site without any intraperitoneal infection or organ damage. CONCLUSION: Combined transgastric and transcolonic approach appears safe and feasible and facilitates translumenal intraperitoneal interventions.

Treatment of gastric varices by endoscopic sclerotherapy using butyl cyanoacrylate: 10 years' experience of 635 cases.

BACKGROUND: Gastric varices (GV) are life-threatening for patients with portal hypertension. Endoscopic injection with butyl cyanoacrylate (BC), the mainstay of the therapy for GV, has been reported to be effective for hemostasis of bleeding varices, but its efficacy in the obliteration of GV and impact on the survival of patients still needs clarification. Here we summarized our experience of 10 years' practice to evaluate the efficacy and safety of endoscopic therapy using BC for GV patients. METHODS: From January 1997 to April 2006, GV cases treated with endoscopic injection using BC were collected. The "sandwich method" and the "modified sandwich method" were used to inject BC intravascularly. Retrograde analysis was made on the data of treatment and follow-up. RESULTS: A total of 635 GV cases treated with endoscopic injection using BC were collected, most of them (90.2%) suffered from post-hepatitis cirrhosis. Emergency hemostasis was achieved in 139 out of 146 sessions (95.2%). Complications occurred in 32 cases (5.2%), including hemorrhage due to early expulsion of tissue glue (3.1%), septicemia (1%) and ectopic thrombosis (0.5%), such as spleen infarction. Endoscopic follow-up in 503 patients showed complete disappearance (76.9%), collapse (17.3%) or remnants (5.8%) of gastric varices. A total of 550 patients were followed up clinically for 3 to 115 months. Of these patients, 44 had recurrent bleeding (8.0%) and 44 died from hepatic failure, recurrent bleeding, hepatic carcinoma or other causes. The longest survival was 115 months, with a median survival of 25 months. Survival rates at 1, 2, 3, 4 and 5 year were 95%, 92%, 90%, 83% and 81%, respectively. CONCLUSIONS: Endoscopic sclerotherapy with BC is effective for the hemostasis of bleeding GV, as well as obliteration of GV which contributes to less rebleeding and better survival. The modified sandwich method may be useful to minimize ectopic embolism, which we speculated to result from excess iodized oil.

Pancreatic encephalopathy and Wernicke encephalopathy in association with acute pancreatitis: a clinical study.

AIM: To investigate clinical characteristics and therapy of pancreatic encephalopathy (PE) and Wernicke encephalopathy (WE). METHODS: In a retrospective study of 596 patients with acute pancreatitis (AP), patients with PE were compared to those with WE in regards to history, clinical manifestation, diagnosis, treatment and outcome. RESULTS: There were 93 patients with severe acute pancreatitis (SAP). Encephalopathies were discovered in 10 patients (1.7%). Six patients with PE all developed in SAP (6.5%), and three of them died (3% of SAP, 50% of PE). Four patients with WE developed in AP (0.7%), and two of them died (0.3% of AP, 50% of WE). Two patients with WE were treated with parenteral thiamine and survived. Global confusions were seen in all patients with encephalopathy. Ocular abnormalities were found. Conjugate gaze palsies were seen in 1 of 6 (16.7%) patients with PE. Of 4 patients with WE, one (25%) had conjugate gaze palsies, two (50%) had horizontal nystagmus, three (75%) had diplopia, and one (25%) had myosis. Ataxia was not seen in all patients. None of patients with WE presented with the classic clinical triad. CSF examinations for 2 patients with WE showed lightly-increased proteins and glucose. CT and MRI of the brain had no evidence of characteristic abnormalities. CONCLUSION: PE occurs in early or reiteration stage of SAP, and WE in restoration stage of SAP/AP. Ocular abnormalities are the hallmarks of WE, and horizontal nystagmus is common. It is difficult to diagnose earlier an encephalopathy as PE or WE, as well as differentiate one from the other. Long fasting, hyperemesis and total parenteral nutrition (TPN) without thiamine are main causes of thiamine deficiency in the course of pancreatitis.