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Gastroesophageal variceal bleeding is the life-threating complication of cirrhotic portal hypertension, and transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for portal hypertension-related complications. TIPS can be used for the prevention of first-time bleeding in patients with recurrent or intractable ascites. TIPS should be performed as early as possible for patients at a high risk of acute variceal bleeding (Child-Pugh class C 7 points with active bleeding on endoscopy or hepatic venous pressure > 20 mmHg). TIPS is an effective salvage therapy for acute variceal bleeding with failure after standard treatment, and is also a second-line option for preventing variceal rebleeding.
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Objective To estimate the diagnostic value of cytology, DNA-ICM(DNA-image cytometry),cytology combined with DNA-ICM for pancreatic malignancy,and to explore the cut-off value for DNA-ICM. Methods Patients with suspicious pancreatic malignancy were retrospectively identified. In total,145 EUS-FNA specimens acquired from 140 separate patients were examined by cytology and DNA-ICM. Diagnostic values among cytology, DNA-ICM and the combination of the techniques in detecting pancreatic malignancy were compared. Results Compared with cytology, DNA-ICM had a lower sensitivity (63.0% VS 82.4%)and accuracy(69.7% VS 85.5%). After combining the techniques, the diagnostic value for pancreatic malignancy significantly improved compared with that by cytology(0.941 VS 0.912, P=0.007 0)or DNA-ICM only(0.941 VS 0.815, P<0.000 1). By using the Youden index, the cut-off value for DNA-ICM to detect pancreatic malignancy was one cell with DI(DNA index)≥2.5. Notably,with this standard, the sensitivity and accuracy of DNA-ICM significantly increased to 72.3% and 77.2%, and those of the combined techniques increased to 91.6% and 93.1%, respectively. Conclusion Automated DNA-ICM is an objective and effective method for pancreatic malignancy. Although DNA-ICM has a lower diagnostic value than that of conventional cytology, an improved value was obtained after combining the techniques.
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Fecal microbiota transplantation (FMT) has become a research focus of biomedicine and clinical medicine in recent years. The clinical response from FMT for different diseases provided evidence for microbiota-host interactions associated with various disorders, including Clostridium difficile infection, inflammatory bowel disease, diabetes mellitus, cancer, liver cirrhosis, gut-brain disease and others. To discuss the experiences of using microbes to treat human diseases from ancient China to current era should be important in moving standardized FMT forward and achieving a better future. Here, we review the changing concept of microbiota transplantation from FMT to selective microbiota transplantation, methodology development of FMT and step-up FMT strategy based on literature and state experts' perspectives.
الموضوعات
Humans , Clostridium Infections , Therapeutics , Fecal Microbiota Transplantation , Methods , Reference Standards , Host Microbial Interactions , Inflammatory Bowel Diseases , Therapeutics , Metabolic Diseases , Therapeuticsالملخص
Holistic integrative medicine is the road to the future of the development of burn medicine. Not only burn medicine, but also human medicine gradually enters the era of holistic integrative medicine. Holistic integrative medicine is different from translational medicine, evidence-based medicine or precision medicine, which integrates the most advanced knowledge and theories in medicine fields with the most effective practices and experiences in clinical specialties to form a new medical system.
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Esophagogastric variceal bleeding is a life-threatening complication of cirrhotic portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective method for the treatment and prevention of esophagogastric variceal bleeding; however, right timing of TIPS and selection of appropriate candidates for TIPS are of vital importance in improving patients’ survival rate and reducing mortality rate. This article reviews the intended population and right timing of TIPS for the treatment and prevention of esophagogastric variceal bleeding in liver cirrhosis.
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[Summary] Holistic integrative medicine ( HIM ) is an ultimate direction and a new way for medical development. It emphases the organic integration of the most advanced knowledge and theories in medical sciences with the most valuable clinical experiences. Treating ( endocrine and metabolic diseases) patients with the concept of HIM, and implementing practical strategies will greatly accelerate the advancement of HIM.
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Objective To explore a highly sensitive and highly specific method to detect the serum MG7 antigen (Ag) level for early gastric cancer diagnosis.Methods The serum MG7-Ag level was detected by enzyme-linked immunosorbent assay (ELISA) method in 116 preoperative gastric cancer patients,63 postoperative gastric cancer patients,41 patients with precancerous lesion,37 patients with precancerous diseases,50 healthy individuals and 281 patients with other cancers.Meanwhile,the expression of MG7-Ag was also examined with immunohistochemistry in patients with gastric cancer or precancerous lesion.Chi-square test was used for comparing positive rates of the two detection methods.Results The positive rate of MG7-Ag determined by ELISA was 83.6％(97/116) of preoperative gastric cancer patients,45.2％(28/62) of lung cancer patients,45.5％(20/44) of rectal cancer patients,17.6％ (12/68) of colonic cancer patients,14.2％ (6/42) of breast cancer patients,47.6％ (30/63) of postoperative gastric cancer patients,19.5 ％ (8/4 1) of patients with precancerous lesions,5.4 ％ (2/37) of patients with precancerous diseases and 0 of healthy individuals.The sensitivity of ELISA (83.6 ％) was similar with that of immunohistochemistry (94.0％)(P＞0.05).However,the false positive rate of ELISA (12.8 ％) was lower than that of immunohistochemistry (51.3 ％) (x2 =26.491,P＜0.01).There was statistically significant difference in MG7 Ag expression in gastric cancer with different clinical stages (x2=15.564,P＜0.01).Conclusion This ELISA method might be a non-invasive screening method for population with high risk of gastric cancer.
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Although liver cirrhosis is the most common cause of portal hypertension (PH), about 20% of PH cases are caused by non-cirrhotic reasons, which are referred to as non-cirrhotic portal hypertension (NCPH), with a high incidence rate in developing countries. NCPH is a group of heterogeneous hepatic vascular diseases, including idiopathic portal hypertension (IPH) and extrahepatic portal vein obstruction (EHPVO), as well as the rare diseases in clinical practice such as Budd-Chiari syndrome, congenital hepatic fibrosis, and nodular regenerative hyperplasia. The patients with NCPH usually have the symptoms of portal hypertension, such as recurrent variceal bleeding and splenomegaly, but liver function is well preserved in these patients. At present, the diagnosis of NCPH lacks a universally accepted standard and remains a challenge. In clinical practice, the method of exclusion is usually applied for the diagnosis of HCPH, and liver biopsy is performed when necessary to make a confirmed diagnosis. This paper introduces the pathogenesis and pathological manifestations of IPH and EHPVO, as well as the selection of diagnostic methods and therapeutic strategies. If upper gastrointestinal bleeding can be effectively controlled, NCPH is considered to have a relatively good prognosis.
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<p><b>OBJECTIVE</b>To examine the expression of cytokine-induced apoptosis inhibitor1 (CIAPIN1) in gastric cancer and normal mucosa tissues, and to investigate its effects on migration and invasion of gastric cancer cells.</p><p><b>METHODS</b>Immunohistochemistry was used to detect CIAPIN1 expression in 15 samples of normal gastric mucosa tissues, 148 samples of gastric cancer tissues (42 of non-metastasis gastric cancer tissues without other organs or lymph node metastasis, 106 of metastasis gastric cancer tissues with lymph node metastasis), and 37 samples of gastric cancer lymph node metastasis tissues. Association of CIAPIN1 expression with clinicopathological characteristics of gastric cancer was analyzed by Chi-square test. SGC-7901 cell lines of high CIAPIN1 expression and low CIAPIN1 expression were established. Transwell assay was applied to detect the invasion and migration of CIAPIN1-regulated gastric cancer cells.</p><p><b>RESULTS</b>Positive rate of CIAPIN1 expression in gastric cancer tissues was lower than that in normal gastric mucosa tissues (41.2% vs. 86.7%, P=0.0008), and in metastasis gastric cancer tissues was also lower than that in non-metastasis gastric cancer tissues (34.9% vs. 71.4%, P=0.0000). Furthermore, the positive rate of CIAPIN1 expression was closely related to the TNM staging of gastric cancer (TNM stage I(, II( and III( were 55.0%, 53.5% and 24.4%, respectively, P=0.0037). But there was no significant difference of positive expressive rate between metastatic gastric cancer tissues and metastatic lymph node tissues(34.9% vs. 21.6%, P=0.3700). Transwell assay showed that up-regulated CIAPIN1 expression would significantly reduce, while down-regulated CIAPIN1 expression would significantly promote the invasion and migration of SGC-7901 cells (all P<0.05).</p><p><b>CONCLUSION</b>Positive rate of CIAPIN1 expression is low in gastric cancer tissues and shows inhibition of invasion and migration of gastric cancer cells.</p>
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Humans , Cell Line, Tumor , Down-Regulation , Immunohistochemistry , Intracellular Signaling Peptides and Proteins , Metabolism , Lymphatic Metastasis , Neoplasm Staging , Stomach Neoplasms , Metabolism , Up-Regulationالملخص
In patients with liver cirrhosis,variceal bleeding is a common fatal complication of portal hypertension.Varices are present in al-most half of patients with cirrhosis at the time of diagnosis.Since transjugular intrahepatic portosystemic shunt (TIPS)was first applied clini-cally in 1988,the relevant information about TIPS has been continually updated and perfected by lots of clinical trials.The role of TIPS in the prevention and treatment of variceal bleeding in cirrhotic patients with portal hypertension,including primary prevention of variceal bleeding,treatment of acute variceal bleeding,and prevention of rebleeding,is reviewed.TIPS is an effective treatment for variceal bleeding in cirrhotic patients with portal hypertension.Along with the technical development,TIPS will be available for more and more patients and will play an increasingly important role in the prevention and treatment of variceal bleeding among cirrhotic patients with portal hypertension.
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Objective To assess and compare the efficacy and safety of ecabet sodium-based quadruple therapy versus bismuth-based quadruple therapy for Helicobacter pylori (Hp) eradication.Methods A multicenter,randomized,positive controlled clinical trial was carried out.The object of the study were chronic gastritis patients at 8 hospitals in Xi'an,Beijing,Shanghai and Guangzhou from June 2009 to June 2011.All patients were divided into treatment group and control group.In treatment group,patients received ecabet sodium-based quadruple therapy (two times per day,omeprazole magnesium 20 mg,amoxicillin 1000 mg,clarithromycin 500 mg and ecabet sodium 1.0 g each time for 10 days.In control group,patients were assigned to receive bismuth-based quadruple therapy (two times per day; omeprazole magnesium 20 mg,amoxicillin 1000 mg,clarithromycin 500 mg and bismuth potassium citrate 220 mg each time) for 10 days.The Hp eradication was determined by 13C or 14C urea breath test at the 38th day after the treatment and the eradication rate was calculated.Side effects were recorded and analyzed.The data were analyzed by chi square test and Fisher's exact test.Results A total of 311 patients were recruited,and 155 patients were allatted in treatment group and 156 in control group.The per-protocol (PP) analysis indicated that the eradication rates of treatment group arid control group were 75.71％(106/140) and 77.37％(106/137) respectively,and there was no significant difference x2 =0.106,P=0.745).The intention-to-treat (ITT) analysis indicated that the eradication rates of treatment group and control group were 68.39％ (106/155) and 67.95％ (106/156) respectively,and there was no significant difference x2 =0.007,P=0.934).The side effects rates of treatment group and control group were 20.00％ (31/155) and 25.64％(40/156) respectively,and the difference was not statistically significant (Fisher's exact test,P=0.280).No serious side effect was observed in two groups.Conclusion The efficacy and safety of ecabet sodium-based quadruple therapy for Hp eradication in chronic gastritis patients may be the same as bismuth-based quadruple therapy.
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Objective To synthesize H.pylori bacterial ghosts (BG) and loaded with adriamycin.The cytotoxic effects in gastric cancer cell line were also observed.MethodsThe lysis plasmid was introduced into H.pylori by bacterial conjugation. H.pylori BG were produced by inducing H.pylori lysis at 42 ℃.After suspension and centrifuge, H.pylori BG were loaded with adriamycin.The adriamycin loading quantity was measured with spectrophotometry.The cytotoxic effects of H.pylori BG-adriamycin in gastric cancer cell line SGC7901 were evaluated with MTT assay.ResultsH.pylori BG were successfully synthesized and loaded with adriamycin.The loading quantity of adriamycin was 70.4 μg/mg.H.pylori BG were seen to be adsorbed and internalized by gastric cancer cells under confocal microscope, which distributed on the surface or cytoplasmic of SGC7901 cell line. Carried Adriamycin was delivered into gastric cancer cell line and mainly accumulated in the nucleus.IC50 of SGC7901 to H.pylori BG-adriamycin was 0.32 ± 0.15 by MTT assay, which was significantly lower than that to free adriamycin (0.44 ±0.15, P＜0.05).Conclusions The proliferation of gastric cancer cells were effectively inhibited by H.pylori BG-adriamycin.H.pylori BG are expected to be ideal carrier for anti-gastric cancer medicine.
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Objective To analyze the prognostic factors in treating variceal hemorrhage patients of liver cirrhosis and portal hypertension with transjugular intrahepatic portosystemic shunt (TIPS).Methods From January 2003 to December 2008, the data of 162 variceal hemorrhage patients with liver cirrhosis and portal hypertension treated with TIPS was collected, which included basic information, biochemical examination results within 7 days before the operation, regular follow-up observation after the surgery and survival data. The survival prognostic indexes were assessed with Cox regression model. Results The successful rate of TIPS was 99% (161/162). The median follow up duration was 21 months. Child-Pugh score and blood platelet count (PLT) were closely correlated with survival (P = 0. 003 and 0. 024). The total cumulative survival rate in patients with Child-Pugh score below nine (75%, 102/136) was higher than over nine (50%, 13/26) (χ2 = 9. 12,P=0. 003).The total cumulative survival rate of patients with PLT count over 47 ×109/L (74%, 82/112) was higher than below 47 × 109/L(66 %, 33/50, χ2 =4. 528, P = 0. 033). The one year after operation cumulative survival rate of liver function Child-Pugh class A, B, and C was 92%, 85%, 55% respectively. Conclusion Child-Pugh score and platelet count are independent predictable factors for the survival of variceal hemorrhage patients with liver cirrhosis and portal hypertension treated by TIPS. The risk increase after operation when Child-Pugh score over 9 and/or PLT count less 47×109 /L.
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Objective To evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA) in treating Budd-Chiari syndrome (BCS) and to analyze the long-term follow-up results. Methods From October 1998 to May 2008,98 BCS patients (inferior vena cava obstruction,n = 34 ; hepatic vein obstruction, n = 22; combined obstruction, n = 42) who accepted PTA treatment successfully were investigated. The changes of clinical manifestations and liver function post-operation were observed; the long term survival rate was evaluated. Results Only two patients were complicated with transhepatic puncture tract bleeding, the prognosis was good after emergency operation. Sixty patients presented with low extremities edema, which was fully subsided after PTA.Of eighty-eight ascites patients, ascites disappeared in eighty patients after operation, and in the other eight patients combined with oral diuretic treatment post-operation. The median Rotterdam prognostic score of one month post-operation and the last follow-up time point was 0. 11 and 0. 09, significantly lowered than pre-operation (1.12). The difference was statistical significance (P=0. 000). At 1, 3, 5 years postoperative, the cumulative vessel patency rates were 96%, 94% and 94% respectively, and the cumulative survival rates were 94%, 91% and 87%. Conclusions Treating BCS with PTA has a high success rate, a good safety and a long-term survival rate.
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Objective To evaluate the therapeutic efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of portal hypertension of patients with hepatocellular carcinoma.Methods Ninety-five portal hypertension patients with hepatic carcinoma were enrolled.TIPS was performed in 63 patients and the other 32 patients received support medical care.The data referred to survival time of the 95 patients after treatment was collected by follow-up visit.The informations about success rate of TIPS,hepatic encephalopathy,rebleeding and causes of death were assessed.The Kaplan-Meier method was used to compare the survival time between two groups.The association of survival time with Child-Pugh classification and model for end-stage liver disease (MELD) score was analyzed.Results The success rate of TIPS was 97.8% with reduction of mean portal vein pressure of 13.6 cmH2O(1 cmH2O=0.098 kPa).The incidence of hepatic encephalopathy was 20.6% and rebleeding was 26.3% six months after TIPS treatment.Fifty-six patients treated with TIPS died at the end of follow-up.Twelve of which were died of variceal bleeding complicated with portal hypertension.The median survival time of TIPS group (3.67 months) was significantly longer than that of control group (1 month). Moreover, the median survival time in patients with low MELD score (≤13) was significantly longer than that in those with high MELD seore (＞13, x2=4.71,P=0.03). Whereas the median survival time was decreasing from Child-Pugh A to C(x2=15.6,P=0.00). Conclusions TIPS is one of effective and safe therapeutic methods to control portal hypertension. However, liver function is an important factor for selcetion of TIPS.
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Objective To investigate the currents impact on delayed rectifier potassium (HERG)regulated by cyclooxygenase (COX)-2 in gastric cancer cells and its mechnism. Methods ① The HERG mRNA, protein and current in gastric cancer cells transfected with or without COX-2 antisense vector were measured by RT-PCR, Western blot and patch-clamp, respectively. ② cAMP concentration in gastric cancer cells transfected with or without COX-2 antisense vector was measured by ELISA. ③ The mutant HERG, which was absence of cAMP-binding domain, was constructed by PCR and transfected into gastric cancer cells. ④ The impact of COX-2 inhibitor and proglandin (PG) E2 on HERG current in gastric cancer cells transfected with or without mutant HERG was investigated by patch clamp. ⑤ The effects of agonist and antagonist of cAMP and inhibitor of protein kinase (PK) A on HERG current in gastric cancer cells transfected with or without HERG mutant were observed by patch clamp. Results ① The expression of HERG mRNA and protein in gastric cancer cells transfected with COX-2 antisense vector were not altered, but the amplitude of HERG current was diminished (P<0.05). ② The cAMP concentration in gastric cancer cells transfected with COX-2 antisense vector was lower than that in parental gastric cancer cells (P<0.05). ③ COX-2 inhibitor and PGE2 had influence on the HERG currents in gastric cancer cells. COX-2 inhibitor reduced and PGE2 enhanced the amplitude of HERG current in gastric cancer cells. However, neither COX-2 inhibitor nor PGE2 showed any negative or positive effects on currents of mutant HERG. ④ cAMP agonist enhanced the amplitude of HERG current and cAMP antagonist reduced the amplitude in gastric cancer cells. Neither agonist nor antagonist had effect on currents of mutant HERG. ⑤ PKA inhibitor did not influence the HERG current of parental gastric cancer cells and gastric cancer cells transfected with mutant. Conclusions COX-2 regulates HERG current through its catalytic product of PGE2, which binds with its receptor on the gastric cancer cells and alters cAMP level in gastric cancer cells, cAMP interacts with HERG protein by binding with cAMP-binding domain of HERG protein and exerts impact on HERG current. PKA does not participate in this process.
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Triptolide, a diterpenoid triepoxide from the traditional Chinese medicinal herb Tripterygium wilfordii Hook. f., is a potential treatment for autoimmune diseases as well a possible anti-tumor agent. It inhibits proliferation of coloretal cancer cells in vitro and in vivo. In this study, its ability to block progress of colitis to colon cancer, and its molecular mechanism of action are investigated. A mouse model for colitis-induced colorectal cancer was used to test the effect of triptolide on cancer progression. Treatment of mice with triptolide decreased the incidence of colon cancer formation, and increased survival rate. Moreover, triptolide decreased the incidence of tumors in nude mice inoculated with cultured colon cancer cells dose-dependently. In vitro, triptolide inhibited the proliferation, migration and colony formation of colon cancer cells. Secretion of IL6 and levels of JAK1, IL6R and phosphorylated STAT3 were all reduced by triptolide treatment. Triptolide prohibited Rac1 activity and blocked cyclin D1 and CDK4 expression, leading to G1 arrest. Triptolide interrupted the IL6R-JAK/STAT pathway that is crucial for cell proliferation, survival, and inflammation. This suggests that triptolide might be a candidate for prevention of colitis induced colon cancer because it reduces inflammation and prevents tumor formation and development.
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Animals , Humans , Male , Mice , Cell Transformation, Neoplastic/drug effects , Colitis/complications , Colonic Neoplasms/chemically induced , Dextran Sulfate/toxicity , Dimethylhydrazines/toxicity , Diterpenes/administration & dosage , Epoxy Compounds/administration & dosage , Interleukin-6/biosynthesis , Janus Kinases/metabolism , Mice, Inbred BALB C , Mice, Inbred ICR , Mice, Nude , Neoplasm Transplantation , Phenanthrenes/administration & dosage , STAT3 Transcription Factor/metabolism , Signal Transduction/drug effects , Tumor Burden/drug effects , rac1 GTP-Binding Protein/biosynthesisالملخص
Objective To evaluate the effect of hepatic vein occlusion and stent replacement in treatment for Budd-Chiari syndrome(BCS).Methods Forty three patients with BCS were underwent percutanous puncture,radiography,transjugular angioplasty,balloon dilation and stent placement for hepatic vein under Doppller ultrasounographic guidance from July 2001 to September 2006. Results Technical success was 100%with no complications.The medium vein pressure was reduced from 32.5 tO 20 cm H2O(1 cm H2O-0.098 kPa)after stents replacement(P＜0.01).The hepatic vein angioplasty revealed that all stents were patent and branches were disappeared.The symptoms in 38 patients were disappeared immediately,and improved in 5 patients.All patients were followed up of 32 months(ranged 1-62).Except one patient died of severe gastric bleeding,the 42 patients were survived with symptoms free.Conclusion Hepatic vein occlusion and stent replacement are safe and effective in treatment of BCS.
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Objective To evaluate the expression of KAII (CD82) gene inhibited by small interfering RNA (siRNA) in human pancreatic cancer cell line T3. Methods Four sequences of siRNA including A, B,C, D were designed, which were based on the KAI1 gene sequence using online RNA interfering designing software and lentivirus vector was built. Then they were used to transfect T3 cells by liposome 2000 and virus titer was determined. Empty vector containing siRNAd1 lentivrus particle ( MOI =5) was also used to infect T3 cells. The expression of CD82 mRNA was detected by real-time PCR. Results The expression of CD82 mRNA in normal control group, empty vector group, A group, B group, C group, D group were 1. 398 ±0.242,1. 311±0.048, 0. 664 + 0. 093, 0. 345 ± 0. 032, 0. 641 ± 0. 049 and 0. 147 ± 0. 049, respectively, the difference between the expression of CD82 mRNA in empty vector group and that of A, B, C, D groups was significant (P＜0.01 ). Conclusions RNAi was able to inhibit the expression of KAI1 gene CD82 in human pancreatic cancer cell line T3.
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<p><b>OBJECTIVE</b>To establish attenuated Salmonella typhimurium producing Helicobacter pylori (H. pylori) urease subunit B (UreB) and determine whether it could be used as an oral vaccine against H. pylori.</p><p><b>METHODS</b>H. pylori (SS1 strain) UreB gene fragment amplified by PCR was cloned into the prokaryotic expression vector pTC01 after sequencing, and then transformed into attenuated Salmonella typhimurium SL3261 to acquire SL3261/pTC01-UreB. The expression of H. pylori UreB in SL3261 was detected by Western blot. Twelve weeks after oral immunization of mice, antibody responses were evaluated using serum and intestinal fluid by ELISA assay. Interferon-gamma (IFN-gamma) and interleukin-10 (IL-10) in the supernatant of spleen cells culture were also assessed by ELISA. In vitro stability of pTC01-UreB plasmid in SL3261 was confirmed by growing in Luria Broth (LB) medium to 80 generations.</p><p><b>RESULTS</b>The UreB gene fragment amplified by PCR was consistent with the sequence of the H. pylori UreB as evidenced by sequence analysis. Enzyme digestion revealed that the correct pTC01-UreB was obtained. Western blot showed that a 61kDa protein was expressed in SL3261/pTC01-UreB, which could be recognized by anti-H. pylori UreB antiserum. After 80 generations of continuous culture, the recombinant plasmid pTC01-UreB was stable in SL3261 and had no obvious toxicity. Multiple oral immunizations with SL3261/pTC01-UreB could significantly induce H. pylori-specific mucosal IgA response as well as serum IgG response. Moreover, there were significant increases of IFN-gamma and IL-10 in the SL3261/pTC01-UreB group. Finally, no obvious side effects for mice and no change in gastric inflammation were observed.</p><p><b>CONCLUSION</b>Attenuated Salmonella typhimurium expressing H. pylori UreB may be used as oral vaccine against H. pylori infection.</p>