Efficacy and safety of Sandwich method with lauromacrogol for gastric varices: a meta-analysis / 中华消化内镜杂志

Objective:To systematically evaluate the efficacy and safety of tissue adhesive combined with lauromacrogol (modified Sandwich method) for gastric varices.Methods:Literature in the Cochrane Library, PubMed, EMbase, CNKI, VIP and Wanfang were searched by two independent researchers from the establishment of the databases to June 30, 2020, and qualified data from the eligible literature were extracted. Revman 5.3 was used to analyze outcomes including hemostatic efficiency, incidence of postoperative fever, chest and abdominal pain, ulcer, ectopic embolism and complications, and postoperative re-bleeding rate (Mantel-Haenszel method).Results:A total of 8 randomized controlled trials including 898 patients were included in this meta-analysis. The results showed that compared with the classic Sandwich method, the modified version had a better hemostatic effect ( P=0.01, OR=2.07, 95% CI: 1.17-3.68) and a lower incidence of postoperative ectopic embolism ( P=0.001, OR=0.06, 95% CI: 0.01-0.34). There were no significant differences in the incidences of postoperative fever ( P=0.58, OR=0.86, 95% CI: 0.52-1.44), chest and abdominal pain ( P=0.83, OR=0.95, 95% CI: 0.58-1.56), local ulcer ( P=0.31, OR=0.66, 95% CI: 0.30-1.47) , re-bleeding ( P=0.14, OR=0.76, 95% CI: 0.53-1.09) or overall incidence of adverse reactions ( P=0.24, OR=0.66, 95% CI: 0.33-1.32). Conclusion:The modified Sandwich method of tissue adhesive combined with lauromacrogol is an effective and safe method in the treatment of gastric varices.

Investigation on Sleep Quality and Psychological Status in Patients With Irritable Bowel Syndrome / 胃肠病学

Background:Irritable bowel syndrome(IBS)is a commonly seen functional gastrointestinal disorders(FGIDs),and can reduce the quality of life and has some effects on patients'psychology. Aims:To investigate the disorder of sleep and psychological status in patients with IBS and IBS overlapping other FGIDs,and to analyze their risk factors. Methods:Questionnaires were conducted among FGIDs patients from January 2014 to December 2014 in 6 hospitals at Tianjin. Pittsburgh sleep quality index(PSQI)was used to assess sleep quality,anxiety and depression were assessed by self-rating anxiety scale(SAS)and self-rating depression scale(SDS),respectively. Two-factor Logistic regression analysis was used to analyze the risk factors of sleep disorder in patients with IBS overlapping other FGIDs. Results:A total of 1 117 patients with FGIDs completed the questionnaires,including 32 IBS patients(2. 9%)and 113 patients(10. 1%)with IBS overlapping other FGIDs. The percentages of sleep disorder,psychological disorder,and combination of the two were 59.4%,93.8% and 59.4% in IBS group,respectively;and 82.3%,95.6% and 78.8% in IBS overlapping other FGIDs group,respectively. Gender,age and severity of symptoms were the risk factors of sleep disorder in patients with IBS overlapping other FGIDs(P=0.014,P=0.049,P=0.025). Conclusions:Both IBS patients and IBS overlapping other FGIDs patients are associated with varying degrees of sleep disorder and/or psychological disorder. Gender,age and severity of symptoms may be the risk factors of sleep disorder in IBS overlapping other FGIDs patients.

A clinical investigation of patients with functional gastrointestinal disorders complicated with sleep disorders / 中华消化杂志

Objective To analyze the status of sleep disorders in patients with functional gastrointestinal disease (FGID) and its relation with symptom characteristics .Methods From January to December 2014 ,questionnaire was carried out in FGID patients who met the Rome Ⅲ criteria and visited the outpatient department of gastroenterology at six third-level general hospitals in Tianjin City to assess the severity of symptoms ,sleep quality (Pittsburgh sleep quality index ,PSQI) ,and psychological state (anxiety and depression) .Chi-square test and Mann-Whitney rank sum test were performed for statistical analysis .Results Among 931 patients with FGID ,651 (69 .92％ ) patients had sleep disorders and 280 (30 .08％ ) patients had no sleep disorders .Among 828 patients with functional dyspepsia (FD) ,360 (43 .48％ ) patients had sleep disorders complicated with and depression .Among 292 patients with irritable bowel syndrome (IBS ) , 138 (47 .26％ ) had sleep disorders complicated with anxiety and depression .Among 618 patients with FD complicated with sleep disorders , 70 (11 .33％ ) patients overlapped with IBS ;among 210 patients with FD ,but without sleep disorder ,11 (5 .24％ ) patients overlapped with IBS and the percentage of the former was higher than the latter ,and the difference was statistically significant (χ2 =6 .580 , P=0 .01) .The proportion of lower abdominal pain ,sheep fecal or hard stool ,laborious defecation or incomplete defecation in FGID patients without sleep disorder were 22 .14％ (62/280) ,11 .79％ (33/280) ,19 .29％ (54/280) and 27 .86％ (78/280) ,respectively ;which were lower than those of FGID patients with sleep disorders (36 .10％ (235/651) ,21 .20％ (138/651) ,32 .41％(211/651) and 44 .39％ (289/651));and the differences were statistically significant (χ2 =17 .552 ,11 .569 , 16 .566 and 22 .419;all P<0 .01) .FGID patients with sleep disorders have more severe symptoms such as lower abdominal pain , lower abdominal discomfort (non-pain ) , sheep fecal or hard stool , laborious defecation incomplete defecation , and urgency than FGID patients without sleep disorders ;and the differences were statistically significant (Z= -4 .423 ,-1 .973 ,-3 .360 ,-4 .467 ,-4 .550 and -2 .420 ;all P<0 .05) . Conclusions Sleep disorders ,anxiety and depression often coexist in patients with FGID .Sleep disorders are closely related with lower gastrointestinal symptoms in patients with FGID .

Effects of telmisartan on resistin expression in a rat model of nonalcoholic steatohepatitis and insulin resistance / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the effects of telmisartan on expression of resistin in serum and liver under conditions of nonalcoholic steatohepatitis (NASH) and insulin resistance using a rat model system.</p><p><b>METHODS</b>Forty-five male Sprague-Dawley rats were randomly divided into a normal control group (NC, n=10), a model control group (MC, n=15), a polyene phosphatidylcholine prevention group (PP, n=10), and a telmisartan prevention group (TP, n=10). The NC group was given a standard diet and the other groups were given a high-fat diet for 16 weeks in order to induce NASH. At the end of week 12, 5 rats in the MC group were sacrificed for pathology confirmation of the NASH model. At the end of week 12, the TP group was given telmisartan (8.0 mg/kg/d) and the PP group was given polyene phosphatidylcholine (8.4 mg/kg/d) for an additional 4 weeks by intragastric administration. At the end of week 16, all rats were sacrificed and body weights recorded. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglycerides (TG), resistin, insulin and fasting blood glucose were measured. The insulin resistance value, HOMA-IR, was assessed by homeostasis mode assessment. Liver expression of the resistin protein was detected by western blotting and of the resistin mRNA was detected by RT-PCR. The F test and LSD test were used for statistical analyses.</p><p><b>RESULTS</b>Compared to the NC group, the body weight and HOMA-IR of rats in the MC group were significantly increased (P<0.01). The levels of serum resistin, and of resistin protein and mRNA in liver, were significantly higher in the MC group than in the NC group of rats (all P less than 0.01). The body weight of rats in the TP group was significantly lower than those in the MC group (P<0.05). The levels of serrn resistin, resistin protein and mRNA in the liver, and insulin resistance were significantly lower in the TP group than in the MC group of rats (all P<0.01). The PP group did not show significant differences in any of these measures, except for loss of body weight (P<0.05).</p><p><b>CONCLUSION</b>Telmisartan elicits preventive and protective effects in a NASH rat model.Telmisartan may improve insulin resistance in NASH rats by decreasing the expression of serum resistin, and liver resistin protein and mRNA.</p>

Effects of Telmisartan on Insulin Resistance and Oxidative Stress in Nonalcoholic Steatohepatitis Rats / 天津医药

Objective To investigate the effects of telmisartan on insulin resistance and oxidative stress in nonalco?holic steatohepatitis (NASH) rats. Methods Fifty male SD rats were randomly divided into five groups:control group, mod?el group, polyene phosphatidylcholine group, low-dose telmisartan group and high-dose telmisartan group by using random number table (n=10 in each group). Control group was given standard food,the other groups were given high fat diet for 12 weeks to establish NASH rat model. Then intervention groups were given either normal saline 1.0 mL/(kg·d) or polyene phos?phatidylcholine 8.4 mg/(kg·d), or telmisartan 4 mg/(kg·d) or telmisartan 8 mg/(kg·d) for 4 weeks by intragastric adminstra?tion. All rats were sacrificed at the end of the 16th week, the lever of plasma insulin resistance index (HOMA-IR), ALT, AST, TG, TC, MDA, SOD, T-AOC, CAT, GSH-PX and liver homogenate MDA, SOD, GSH-PX and liver NAS scores were tested. Results In polyene phosphatidylcholine treated group, the lever of plasma ALT, AST, HOMA-IR and liver NAS scores were degreased significantly compared with model group. The lever of plasma AST, SOD, T-AOC, CAT, GSH-PX and liver homogenate SOD, GSH-PX, liver NAS scores were improved in both low-dose and high-dose telmisartan groups com?pared with model group while plasma and liver homogenate MDA , HOMA-IR were reduced significantly in these two groups compared with model group. Besides, plasma ALT was significantly improved in high-dose telmisartan group compared with model group. Conclusion Telmisartan reduce plasma ALT, AST, oxidative stress, HOMA-IR and liver NAS scores in NASH rats. And high-does telmisartan is better than low-dose telmisartan and polyene phosphatidylcholine in treatment ef?fect.

Ischemic hepatitis: influence factors and clinical features / 中华老年医学杂志

Objective To investigate the incidence,influencing factors and clinical features of ischemic hepatitis.Methods Changes of serum transaminase and lactate dehydrogenase in patients with shock and respiratory failure were recorded in our hospital.Ischemic hepatitis was identified according to diagnosis guidelines,and its incidence was counted.Clinical data of patients with ischemic hepatitis were recorded.Results There were 53 cases diagnosed as ischemic hepatitis in 317 severe patients,including hemorrhagic shock,heart failure,respiratory failure,et al.The incidence was high in elderly patients aged over 70 years and male.Levels of alanine aminotransferase (ALT),AST and lactic dehydrogenase (LDH) were significantly increased 1-3 days after shock and respiratory failure,then reached to peak value 1-5 days [averaged (3.35±0.89) days] after shock and respiratory failure.Serum ALT was 869-4354 U/L,AST was 773-4833U/L and LDH was 1021-2662 U/L.Total bilirubin level was increased in 16 cases and the total bilirubin was 14-54 μmol/L.AST was declined to a point within 2 times the upper limit of normal range after 9-16 days,averaged (13± 1.6) days.Elevated transaminase level had no correlation with sex,age and pre-existing liver diseases.The time of enzyme changes had no correlation with sex but age and liver diseases.Patients aged ≥ 70 years had later AST peak and the recovery time was longer than younger patients (P＜0.01).Conclusions Ischemic hepatitis occurs mainly in men and elderly people.But advanced age and underlying liver diseases can affect the recovery time of transaminase in patients with ischemic hepatitis.

Protective Effects of Extract of Periplaneta Americana on Liver Fibrosis in Rats / 天津医药

Objective To investigate the protective effects of extract of Periplaneta americana (APA) against carbon tetrachloride (CCl4)-induced hepatic fibrosis in rats. Methods Seventy SD rats were divided into five groups:normal con-trol group (C), model control group (M), extract of APA 1 group (APA1), extract of APA 2 group (APA2) and reduced glutathi-one group (R). The liver fibrosis model was induced by injecting 40%CCl4-olive solution subcutaneously for seven weeks in M, APA1, APA 2 and R groups. Drugs were given at the same time. Rats were killed at 7-week (C, M, APA1 and R groups), and were killed at 9-week (APA2 group). The serum values of transaminase (ALT, AST), albumin (ALB), hyaluronic acid (HA) and laminin (LN), and hepatic inflammation and fibrosis were detected respectively. The expressions of apoptotic relat-ed gene Bcl-2 and Bax protein in central veins and portal areas of hepatic lobules were detected by immunohistochemical method. Results Rats showed poor nutritional status, and significantly increased transaminase, HA and LN in M group, but the serum level of ALB was significantly lower than that in C group. There was extensive necrosis of liver cells, obviously fi-brosis or cirrhosis in model rats’liver tissues. The serum contents of ALT, AST, HA and LN were significantly decreased, the serum level of ALB were significantly increased in APA1,APA2 and R groups (P<0.05). There were complete hepatic lobule and no obvious fibrous tissue hyperplasia in liver biopsy of APA1 and R groups. The values of Bcl-2/Bax proteins in central vein of liver tissues were significantly higher in APA1,APA2 and R groups than those of M group (P<0.05), but the ratio of Bcl-2/Bax was lower in periportal area of liver tissues (P<0.05). There were significantly higher body weight and ALB levels in APA1 group than those in R group (P<0.05). The level of transaminase was slightly higher in APA1 group than that of R group. The degeneration of liver cells was found mostly in R group. Conclusion The extract of Periplaneta americana has a role in protecting liver cells, inhibiting the progression of hepatic fibrosis, and improving the nutritional sta-tus of trial rats.

Risk Factors of Hospital Acquired Infection among Cirrhosis Patients / 中华医院感染学杂志

OBJECTIVE To investigate the incidence of hospital acquired infection among cirrhosis patients and analyze its correlated factors.METHODS The whole case history was analyzed retrospectively.RESULTS The incidence of hospital acquired infection was 21.33%,obviously higher than the average hospital infection rate(9.1%).It contained mainly respiratory tract infections and spontaneous bacterial peritonitis.It was positively correlated with patient's age,hospitalization time,liver function,hypoalbuminemia,leukocyte count,acute upper gastrointestinal bleeding and the invasive operations(P