Efficacy of transjugular intrahepatic portosystemic shunts in treating cirrhotic esophageal-gastric variceal bleeding.

BACKGROUND: Esophageal-gastric variceal bleeding (EGVB) represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes. Interventional therapy, a rapidly developing treatment modality over the past few years, has found widespread application in clinical practice due to its minimally invasive characteristics. However, whether transjugular intrahepatic portosystemic shunt (TIPS) treatment has an impact on patient prognosis remains controversial. AIM: To probing the efficacy of TIPS for treating cirrhotic EGVB and its influence on the prognosis of patients afflicted by this disease. METHODS: A retrospective study was conducted on ninety-two patients presenting with cirrhotic EGVB who were admitted to our hospital between September 2020 and September 2022. Based on the different modes of treatment, the patients were assigned to the study group (TIPS received, n = 50) or the control group (percutaneous transhepatic varices embolization received, n = 42). Comparative analyses were performed between the two groups preoperatively and one month postoperatively for the following parameters: Varicosity status; hemodynamic parameters [portal vein flow velocity (PVV) and portal vein diameter (PVD); platelet count (PLT); red blood cell count; white blood cell count (WBC); and hepatic function [albumin (ALB), total bilirubin (TBIL), and aspartate transaminase (AST)]. The Generic Quality of Life Inventory-74 was utilized to assess quality of life in the two groups, and the 1-year postoperative rebleeding and survival rates were compared. RESULTS: Following surgical intervention, there was an improvement in the incidence of varicosity compared to the preoperative status in both cohorts. Notably, the study group exhibited more pronounced enhancements than did the control group (P < 0.05). PVV increased, and PVD decreased compared to the preoperative values, with the study cohort achieving better outcomes (P < 0.05). PLT and WBC counts were elevated postoperatively in the two groups, with the study cohort displaying higher PLT and WBC counts (P < 0.05). No differences were detected between the two groups in terms of serum ALB, TBIL, or AST levels either preoperatively or postoperatively (P < 0.05). Postoperative scores across all dimensions of life quality surpassed preoperative scores, with the study cohort achieving higher scores (P < 0.05). At 22.00%, the one-year postoperative rebleeding rate in the study cohort was significantly lower than that in the control group (42.86%; P < 0.05); conversely, no marked difference was observed in the 1-year postoperative survival rate between the two cohorts (P > 0.05). CONCLUSION: TIPS, which has demonstrated robust efficacy in managing cirrhotic EGVB, remarkably alleviates varicosity and improves hemodynamics in patients. This intervention not only results in a safer profile but also contributes significantly to a more favorable prognosis.

HMGB2 Deficiency Mitigates Abdominal Aortic Aneurysm by Suppressing Ang-II-Caused Ferroptosis and Inflammation via NF-κß Pathway.

Background: Ferroptosis is a new form of cell death, which is closely related to the occurrence of many diseases. Our work focused on the mechanism by which HMGB2 regulate ferroptosis and inflammation in abdominal aortic aneurysm (AAA). Methods: Reverse transcription-quantitative polymerase chain reaction and western blot were utilized to assess HMGB2 levels. CCK-8 and flow cytometry assays were utilized to measure cell viability and apoptosis. We detected reactive oxygen species generation, Fe2+ level, and ferroptosis-related protein levels in Ang-II-treated VSMCs, which were typical characteristics of ferroptosis. Finally, the mice model of AAA was established to verify the function of HMGB2 in vivo. Results: Increased HMGB2 level was observed in Ang-II-treated VSMCs and Ang-II-induced mice model. HMGB2 depletion accelerated viability and impeded apoptosis in Ang-II-irritatived VSMCs. Moreover, HMGB2 deficiency neutralized the increase of ROS in VSMCs caused by Ang-II. HMGB2 silencing considerably weakened Ang-II-caused VSMC ferroptosis, as revealed by the decrease of Fe2+ level and ACSL4 and COX2 levels and the increase in GPX4 and FTH1 levels. Furthermore, the mitigation effects of shHMGB2 on Ang-II-induced VSMC damage could be counteracted by erastin, a ferroptosis agonist. Mechanically, HMGB2 depletion inactivated the NF-κß signaling in Ang-II-treated VSMCs. Conclusions: Our work demonstrated that inhibition of HMGB2-regulated ferroptosis and inflammation to protect against AAA via NF-κß signaling, suggesting that HMGB2 may be a potent therapeutic agent for AAA.

Efficacy and safety analysis of transarterial chemoembolization and transarterial radioembolization in advanced hepatocellular carcinoma descending hepatectomy.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world, which is seriously threatening the lives of patients. Due to the rapid development of the disease, patients were in the middle and advanced stages at the time of diagnosis and missed the best time for treatment. With the development of minimally invasive medicine, interventional therapy for advanced HCC has achieved promising results. Transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) are currently recognized as effective treatments. This study aimed to investigate the clinical value and safety of TACE alone and combined with TACE in the treatment of progression in patients with advanced HCC and to find a breakthrough for the early diagnosis and treatment of patients with advanced HCC. AIM: To investigate the efficacy and safety of hepatic TACE and TARE in advanced descending hepatectomy. METHODS: In this study, 218 patients with advanced HCC who were treated in the Zhejiang Provincial People's Hospital from May 2016 to May 2021 were collected. Of the patients, 119 served as the control group and received hepatic TACE, 99 served as the observation group and were treated with hepatic TACE combined with TARE. The patients in two groups were compared in terms of lesion inactivation, tumor nodule size, lipiodol deposition, serum alpha-fetoprotein (AFP) level in different periods, postoperative complications, 1-year survival rate, and clinical symptoms such as liver pain, fatigue, and abdominal distension, and adverse reactions such as nausea and vomiting. RESULTS: The observation group and the control group had good efficacy in treatment efficiency, reduction of tumor nodules, reduction of postoperative AFP value, reduction of postoperative complications, and relief of clinical symptoms. In addition, compared with the control group, the treatment efficiency, reduction of tumor nodules, reduction of AFP value, reduction of postoperative complications, and relief of clinical symptoms in the observation group were better than those in the TACE group alone. Patients in the TACE + TARE group had a higher 1-year survival rate after surgery, lipiodol deposition was significantly increased and the extent of tumor necrosis was expanded. The overall incidence of adverse reactions in the TACE + TARE group was lower than that in the TACE group, and the difference had statistical significance (P < 0.05). CONCLUSION: Compared with TACE alone, TACE combined with TARE is more effective in the treatment of patients with advanced HCC. It also improves postoperative survival rate, reduces adverse effects, and has a better safety profile.

Clinical efficacy comparison of sclerosing embolization with 3% polidocanol and the microsurgical subinguinal varicocelectomy in primary varicocele patients.

Varicocele is a more common male genitourinary system disease with sperm quality dysfunction or discomfort. This study was aimed to compare the clinical efficacy of sclerosing embolization with 3% polidocanol and the microsurgical subinguinal varicocelectomy in treating primary varicocele. Total of 59 patients with primary varicocele receiving a 3-month postoperative follow-up were included to analyse their biochemical parameters and clinical outcomes, including the operative time, hospitalization time, postoperative recurrence rates, and complication rate. Nineteen patients were treated with sclerosing embolization with 3% polidocanol (SE group), while 40 patients were treated with microsurgical subinguinal varicocelectomy (MSV group). For the SE group, 17 patients were treated on the left side, and two patients have treated on both without recurrences and complications during the follow-up period. For the MSV group, three patients were treated bilaterally, and 36 patients were treated separately on the left side with a total 5% recurrence rate and 10% complication rate. The duration of surgery and the hospitalization time of the SE group (46.2 ± 9.79 min and 2.53 ± 0.90 days, respectively) are significantly lower than MSV group (100.5 ± 13.76 min and 3.6 ± 1.58 days, respectively), p < 0.05. The total sperm count at 3 months was significantly higher in the SE group than in the MSV group (p < 0.05). In summary, sclerosing embolization is more effective for varicocele in improving sperm quality, shortening recovery time, and reducing recurrence rates and complications.

Knockdown of Circular Ubiquitin-specific Peptidase 9 X-Linked Alleviates Oxidized Low-density Lipoprotein-induced Injuries of Human Umbilical Vein Endothelial Cells by Mediating the miR-148b-3p/KLF5 Signaling Pathway.

ABSTRACT: There is evidence that the development of atherosclerosis (AS) involves the dysregulation of circular RNAs. This study aimed to investigate the role of circular ubiquitin-specific peptidase 9 X-linked (circUSP9X) in AS cell models. Human umbilical vein endothelial cells (HUVECs) treated with oxidized low-density lipoprotein (ox-LDL) were used as cell models of AS. The expression of circUSP9X, miR-148b-3p, and Kruppel-like factor 5 (KLF5) messenger RNA was measured using quantitative polymerase chain reaction. Cell viability was assessed by Cell Counting Kit-8 assay. Lactate dehydrogenase leakage, malonaldehyde content, and superoxide dismutase activity were investigated using matched commercial kits. Cell apoptosis was detected using flow cytometry assay. The protein levels of apoptosis-related markers and KLF5 were detected by western blot. The release of proinflammatory factors was monitored by enzyme-linked immunosorbent assay. The predicted relationship between miR-148b-3p and circUSP9X or KLF5 was confirmed by dual-luciferase reporter assay or RNA immunoprecipitation assay. CircUSP9X was highly expressed in ox-LDL-treated HUVECs. CircUSP9X knockdown inhibited ox-LDL-induced lactate dehydrogenase leakage, apoptosis, inflammation, and oxidative stress in HUVECs. CircUSP9X directly bound to miR-148b-3p, and KLF5 was a target of miR-148b-3p. CircUSP9X could regulate KLF5 expression by competitively targeting miR-148b-3p. Rescue experiments indicated that circUSP9X knockdown inhibited ox-LDL-induced HUVEC injuries by enriching miR-148b-3p, and miR-148b-3p restoration alleviated ox-LDL-induced HUVEC injuries by degrading KLF5. In conclusion, circUSP9X knockdown relieved ox-LDL-triggered HUVEC injuries during AS progression partly by mediating the miR-148b-3p/KLF5 network.

Combined fenestrated/chimney thoracic endovascular repair for the treatment of blunt traumatic aortic injury: A case report.

Blunt traumatic thoracic aortic injury (BTAI) is an extremely serious medical condition with a high rate of associated mortality. Recent advances in techniques such as thoracic endovascular repair offer new opportunities to manage the critical BTAI patients in an efficacious yet less invasive manner. A 65 year-old-male suffered from multiple injuries after a fall, including BTAI in the aortic arch, which resulted in dissection of the descending thoracic-abdominal aorta and iliac artery, development of an intimal flap in the left common carotid artery, and dissection of the left subclavian artery. Based on the imaging information of this patient and our clinical experience, the combined treatment of fenestrated thoracic endovascular repair and a chimney technique was immediately planned to fully repair these dissections and moreover prevent further dissection of the branching vessels, additionally to ensure sufficient blood flow in the left subclavian artery and left common carotid artery. The intervention yielded satisfactory early outcomes. Follow-up assessment at six months reported no symptoms or complications associated with the stent-graft. Computed tomography angiography further confirmed adequate stent-graft coverage of the aortic injury.

[Endovascular treatment of abdominal aortic aneurysm and aortic bifurcation stenosis by unibody bifurcation stent graft].

OBJECTIVE: To sum up experience in unibody bifurcation stent graft in the treatment of abdominal aortic aneurysm with aortic bifurcation stenosis. METHODS: Clinical data of 19 cases of abdominal aortic aneurysm and aortic bifurcation stenosis received endovascular treatment using unibody bifurcation stent graft in Zhejiang Provincial People's Hospital during March 2009 and March 2018 were collected. The clinical characteristics, surgery procedure and follow-up results were reviewed. RESULTS: Stent graft was successful in all patients, and the average operation time was (70.0±2.3) min. Leakage was found in 3 patients, in which 2 patients with type Ⅰ leakage and 1 patient with type Ⅱ leakage. All leakage disappeared 15 days after surgery. The 19 cases were followed-up for 9-48 months with the median follow-up time of 27 months, and no displacement, leakage and lower limb ischemia was observed. CONCLUSIONS: Unibody bifurcation stent graft is of satisfactory long-term effect for patients with abdominal aortic aneurysm and aortic bifurcation stenosis, and can avoid displacement of stent graft after operation.

Induction of chlamydospore formation in fusarium by cyclic lipopeptide antibiotics from Bacillus subtilis C2.

The culture filtrate of Bacillus subtilis strain C2 showed strong activity against the pathogenic fungus Fusarium solani f. sp. radicicola. A partially purified fraction (PPF) from the extract induced chlamydospore formation in Fusarium. Reverse-phase high performance liquid chromatography yielded 8 different fractions, six of which had chlamydospore-inducing activity. Mass spectrometry and nuclear magnetic resonance analyses identified the main active constituent as C(17) fengycin A (FA17), a cyclic lipopeptide. The effect of FA17 on morphology and physiology of two Fusarium species was dependent on the lipopeptide concentration. When challenged with FA17 at concentrations (0.5, 8, 64 µg ml(-1)) below the minimum inhibitory concentration (MIC) (128 µg ml(-1)), two species of Fusarium formed chlamydospores from hyphae, germ tubes, or inside the conidia within 2 days. At concentrations close to the MIC, FA17 caused Fusarium to form sparse and swollen hyphae or lysed conidia. The other five fractions were identified as fengycin A homologues. The homologues could also induce chlamydospore-like structures in 17 species of filamentous fungi including some specimens that do not normally produce chlamydospores, according to their taxonomic descriptions. Like other chlamydospores, these structures contained nuclei and lipid bodies as revealed by DAPI and Nile Red staining, and could germinate. This is the first study to demonstrate that under laboratory conditions fengycin, an antifungal lipopeptide produced by B. subtilis, can induce chlamydospore formation in Fusarium and chlamydospore-like structures in many filamentous fungi.

Induction of trap formation in nematode-trapping fungi by a bacterium.

Three soil bacterial strains were identified as Chryseobacterium sp. TFB on the basis of their 16S rRNA gene sequences. Conidia of Arthrobotrys oligospora produced a few mycelial traps (MT) and conidial traps (CT) when cultured with bacterial cells that they did not produce when cultured with a bacterial cell-free culture filtrate. However, co-culture of A. oligospora with bacterial cells and bacteria-free filtrate simultaneously induced MT and CT in large amounts. With the increased concentration of bacteria-free filtrate, the number of typical CT increased, but conidial germination was progressively inhibited. Scanning electron microscopy of A. oligospora co-cultured with bacteria revealed that bacterial attachment to hyphae was a prerequisite to trap formation and that bacteria-free filtrate facilitated bacterial attachments to hyphae. The results that the addition of nutrients in co-culture medium decreased the number of traps suggest that this type of trap formation may be favoured at a low nutrient status. Eight fungi tested were able to form MT and CT when co-cultured with bacterial cells and bacteria-free culture filtrate, but the abilities varied among species. This study provides novel evidence that under laboratory conditions, soil bacteria attaching to hyphae could induce traps in nematode-trapping fungi.