Formulation development and evaluation of gastroretentive floating beads with Brucea javanica oil using ionotropic gelation technology.

In the present study, a gastric retention floating system for Brucea javanica oil, composed of alginate and carrageenan, was prepared using ionotropic gelation. Parameters for floatability, drug load, encapsulation efficiency, bead morphology, in vitro release, and in vivo gastric retention were evaluated. The optimized formulation via Box-Behnken design consisted of 1.7% alginate (W/V), 1.02% carrageenan (W/V), 1.4% CaCO3 (W/V), and a gelling bath of pH 0.8. The alginate-carrageenan-Brucea javanica oil beads had a porous structure and exhibited up to 24 h of in vitro floatability with a load capacity of 45%-55% and an encapsulation efficiency of 70%-80%. A 6-h sustained release was observed in vitro. The beads had a prolonged gastric retention (> 60% at 6 h) in fasted rats, compared to non-floating beads (15% at 6 h), as measured by gamma scintigraphy with single-photon emission tomography/computed tomography (SPET/CT). In conclusion, the alginate-carrageenan-Brucea javanica oil system showed enhanced oil encapsulation efficiency, excellent floating and gastric retention abilities, and a favorable release behavior.

Budd-Chiari syndrome in China: A 30-year retrospective study on survival from a single center.

AIM: To investigate 30-year treatment outcomes associated with Budd-Chiari syndrome (BCS) at a tertiary hospital in China. METHODS: A total of 256 patients diagnosed with primary BCS at our tertiary hospital between November 1983 and September 2013 were followed and retrospectively studied. Cumulative survival rates and cumulative mortality rates of major causes were calculated by Kaplan-Meier analysis, and the independent predictors of survival were identified using a Cox regression model. RESULTS: Thirty-four patients were untreated; however, 222 patients were treated by medicine, surgery, or interventional radiology. Forty-four patients were lost to follow-up; however, 212 patients were followed, 67 of whom died. The symptom remission rates of treated and untreated patients were 81.1% (107/132) and 46.2% (6/13), respectively (P = 0.009). The cumulative 1-, 5-, 10-, 20-, and 30-year survival rates of the treated patients were 93.5%, 81.6%, 75.2%, 64.7%, and 58.2%, respectively; however, the 1-, 5-, 10-, 20-, and 30-year survival rates of the untreated patients were 70.8%, 70.8%, 53.1%, 0%, and unavailable, respectively (P = 0.007). Independent predictors of survival for treated patients were gastroesophageal variceal bleeding (HR = 3.043, 95%CI: 1.363-6.791, P = 0.007) and restenosis (HR = 4.610, 95%CI: 1.916-11.091, P = 0.001). The cumulative 1-, 5-, 10-, 20-, and 30-year mortality rates for hepatocellular carcinoma were 0%, 2.6%, 3.5%, 8%, and 17.4%, respectively. CONCLUSION: Long-term survival is satisfactory for treated Chinese patients with BCS. Hepatocellular carcinoma is a chronic complication and should be monitored with long-term follow-up.

[Preparation and formulation investigation of gastric retention calcium alginate microspheres containing Brucea javanica oil].

OBJECTIVE: To investigate the preparation technologies of gastric retention calcium alginate microsphere containing Brucea javanica oil, and to evaluate its formulations. METHODS: The formulations of gastric retention calcium alginate microspheres were optimized with G/M ration and concentration of sodium alginate,use level of iron calcium solution and pore-forming agent, cross-link time and pH value of cross-link solution, which had shown a great effect on microspheres morphology, drug release behavior, drug loaded and encapsulation efficiency. RESULTS: Brucea javanica oil alginate microspheres looked spherical, homogeneous and well distributive. And the drug loaded of Brucea javanica oil was over 40%, encapsulation efficiency was over 70%. CONCLUSION: The prepared gastric retention calcium alginate microspheres have a great sustained release and floating capability, which can provide a strong topical therapy for gastric diseases.

[Contrast of curative effect and complications between peripheral venous thrombolysis and catheter-direct thrombolysis for acute deep venous thrombosis in lower limbs].

OBJECTIVE: To evaluate the effects of catheter-direct thrombolysis in acute deep venous thrombosis (DVT). METHODS: A total of 86 cases were divided into 2 groups of peripheral venous thrombolysis (group A, n = 33) and catheter-direct thrombolysis (group B, n = 53). The curative effect of two groups was compared by swelling rate and vascular potency. RESULTS: No significant difference existed in swelling rate between two groups (P > 0.05). Vascular patency rates of group B was significantly better than those of group A (P < 0.01). The incidence of bleeding had no significant difference (P > 0.05) and there was no asymptomatic pulmonary embolism in two groups. CONCLUSION: Both treatments of acute DVT are effective in improving symptoms. But catheter-directed thrombolysis results in significant vascular patency rate and does not increase the risk of thrombolytic bleeding.

[Acute superior mesenteric ischemia: a contrast study on short-and mid-term result between stent implantation and pharmaceutical thrombolysis].

OBJECTIVE: To compare the short-term and medium-term result of stent implantation with pharmaceutical thrombolysis in patients with acute superior mesenteric artery occlusion. METHODS: From January, 2004 to December, 2008, thirty-five patients diagnosed acute superior mesenteric ischemia, 12 patients treated with stent implantation (interventional therapy group) and 23 patients with pharmaceutical thrombolysis (thrombolytic therapy group). Interventional therapy group treated with balloon dilatation and stent implantation assisted with anticoagulation, antiplatelet and vascular dilation agents. Thrombolytic therapy group used urokinase combined with anticoagulation, antiplatelet and vascular dilation agents. All patients had taken clopidogrel and aspirin orally after discharged and followed up. The clinical effects of both groups were evaluated separately and the Fisher exact test was used to analysis the significant differences. RESULTS: In the 23 cases of thrombolytic therapy group, 7 cases was effective, 16 cases was ineffective (7 cases aggravated or died, 9 cases turn to surgical operation). In the 12 cases of interventional therapy group, 10 cases treated with stent implantation (1 case died of acute cardiac infarction 3 days after interventional operation), 2 cases failed in recanalizing. All patients were followed up after discharged (range 1 - 48 months, mean 15 ± 12 months), 1 case in thrombolytic therapy group was stable, 6 cases died of the recurrence of acute superior mesenteric artery occlusion; 7 cases in interventional therapy group was stable, 1 case died of acute cardiac infarction 20 months after interventional operation (intestinal ischemia not appeared), 1 case had intestinal ischemia reoccurred and recovered by superior mesenteric artery thrombolysis. CONCLUSIONS: In the treatment of acute superior mesenteric ischemia, stent implantation was obviously superior to pharmaceutical thrombolysis in improving intestinal ischemia and survival, therefore it could provided a reliable choice for the patients who had not appeared intestinal necrosis.

[Prevention and treatment of biliary complications following orthotopic liver transplantation].

OBJECTIVE: To study the prevention and treatment of biliary complications after orthotopic liver transplantation. METHODS: Clinical data of 183 recipients who had received liver transplantation between May 1995 and December 2006 were retrospectively analyzed. RESULTS: Biliary complications occurred in 15 patients (15/183, 8.2%). The incidence for short-term and long-term complication were 6.0% (11/183) and 2.2% (4/183) respectively. No biliary complications was due to hepatic artery thrombosis(HAT). Four cases who received PTC(percutaneous transhepatic cholangiography) with stent insertion,8 cases who received ERCP( endoscopic retrograde cholangiopancreatography) with stent insertion and 1 who received Roux-en-Y choledochojejunostomy for anastomotic stricture were successfully cured. Two cases required relaparotomy died for fungus infection eventually. The mortality due to biliary complications was 1.1%. CONCLUSIONS: The rapid combined abdominal organ harvesting technique could shorten the ischemia time and ameliorate the injury due to vascular and bile duct variances, which could reduce the incidence of biliary complication. PTC and (or) ERCP combined with stent insertion were main procedure for biliary complications not related to HAT after liver transplantation.

[Experience in the management of acute superior mesenteric artery ischemia].

OBJECTIVE: To study the management of acute superior mesenteric artery (SMA) ischemia and to improve its prognosis. METHOD: The clinical data of 37 patients treated from January 1996 to August 2007 was retrospectively reviewed. RESULTS: Of the cases, 19 (51.4%) patients were diagnosed with acute SMA embolism, 15 (40.5%) with acute SMA thrombosis, 2 (5.4%) with spontaneous isolated dissection of SMA and 1 (2.7%) with SMA aneurysm. Nineteen (51.4%) patients were misdiagnosed in emergency. Eighteen (48.6%) patients died in the hospital, and most of them died of severe infection and multiple organ failure. Three cases of the survived 19 patients experienced severe complications (2 with short gut syndrome, 1 with cerebral hemorrhage). Nine cases were followed-up for a mean period of 15 months, and 5 died during that term. CONCLUSIONS: Acute SMA ischemia has multiple etiological factors. Early intervention can improve the prognosis.