[Transjugular intrahepatic portosystemic shunt plus embolotherapy in the treatment of gastroesophageal varices: a report of 38 patients].

OBJECTIVE: To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) plus embolotherapy in the treatment of patients with gastroesophageal varices. METHODS: A total of 36 patients with gastroesophageal varices underwent the therapies of TIPS plus embolotherapy from July 2005 to March 2011 at Provincial Hospital Affiliated to Shandong University. The rechecked items included abdominal ultrasound examination, liver function test and blood routine examination at Day 7 post-operation. All received endoscopic examinations at Month 1. RESULTS: The technical success rate of TIPS plus embolotherapy was 100%. The portal vein pressures declined from (28 ± 8) mm Hg (1 mm Hg = 0.133 kPa) to (14 ± 7) mm Hg at post-operation. Angiography showed gastroesophageal varices disappeared in all patients. Both liver function and gastroesophageal varices markedly improved. During the follow-up period of 3 - 6 months, 4 cases had hepatic encephalopathy and 1 case stent restenosis at post-operation. And most cases were resolved after treatment. No rebleeding occurred during the follow-up period. CONCLUSIONS: The combined modality of TIPS plus embolotherapy can effectively lower portal vein pressure and cure esophageal and gastric varice bleeding. As a safe and excellent interventional procedure with fewer complications and a lower recurrence rate of portal hypertension, it has great clinical values in the treatment of portal hypertension and gastroesophageal varices.

Influence of antitumor drugs on the expression of Fas system in SW480 colon cancer cells.

AIMS: To observe the influence of popular antitumor drugs [5-fluorouracil (5-FU), mitomycin (MMC), cisplatin (CP) and all-trans retinoic acid (ATRA)] on the expression of Fas system in SW480 colon cancer cells. METHODS: The expressions of Fas/FasL protein and mRNA in colon cancer line SW480 cells before and after the treatment of the antitumor drugs (5-FU, MMC, CP and ATRA) were detected by immunocytochemistry, flow cytometry and reverse-transcriptase polymerase chain reaction. Coculture assays of colon cancer cells and Jurkat cells (Fas-sensitive cells) were performed to observe the counterattack of colon cancer cells to lymphocytes. Apoptosis of Jurkat cells were detected by flow cytometry and fluorescence microscopy. RESULTS: SW480 expressed high FasL and low Fas without drug treatments. When treated with 5-FU, Fas expression rates in SW480 increased, but FasL remained unchanged. Both Fas and FasL increased significantly when treated with MMC and CP. Most importantly, ATRA could induce SW480 cells to differentiate, increase the expression of Fas and decrease the expression of FasL. The coculture of SW480 cells and Jurkat cells confirmed the function of FasL in the SW480 cells. CONCLUSION: Certain antitumor drugs can change the expression of the Fas system in SW480 cells in different ways. In vitro, MMC and CP can increase the sensitivity of colon cancer cells to apoptosis signals, but they possibly facilitate immune escape of tumor cells. 5-FU results in immune escape of colon cancer cells. ATRA can down-regulate the possibility of counterattack of colon cancer cells.

Prevalence of depression and anxiety in patients with chronic digestive system diseases: A multicenter epidemiological study.

AIM: To investigate the prevalence of depression and anxiety in patients with chronic digestive system diseases. METHODS: A total of 1736 patients with chronic digestive system diseases were included in this cross-sectional study, including 871 outpatients and 865 in-patients. A self-designed General Information for Patients of the Department of Gastroenterology of General Hospitals questionnaire was used to collect each patient's general information, which included demographic data (including age, sex, marital status, and education) and disease characteristics (including major diseases, disease duration, principal symptoms, chronic pain, sleep disorder, and limited daily activities). RESULTS: The overall detection rate was 31.11% (540/1736) for depression symptoms alone, 27.02% (469/1736) for anxiety symptoms alone, 20.68% (359/1736) for both depression and anxiety symptoms, and 37.44% (650/1736) for either depression or anxiety symptoms. Subjects aged 70 years or above had the highest detection rate of depression (44.06%) and anxiety symptoms (33.33%). χ2 trend test showed: the higher the body mass index (BMI), the lower the detection rate of depression and anxiety symptoms (χ2trend = 13.697, P < 0.001; χ2trend = 9.082, P = 0.003); the more severe the limited daily activities, the higher the detection rate of depression and anxiety symptoms (χ2trend = 130.455, P < 0.001, χ2trend = 108.528, P < 0.001); and the poorer the sleep quality, the higher the detection rate of depression and anxiety symptoms (χ2trend = 85.759, P < 0.001; χ2trend = 51.969, P < 0.001). Patients with digestive system tumors had the highest detection rate of depression (57.55%) and anxiety (55.19%), followed by patients with liver cirrhosis (41.35% and 48.08%). Depression and anxiety symptoms were also high in subjects with comorbid hypertension and coronary heart disease. CONCLUSION: Depression and anxiety occur in patients with tumors, liver cirrhosis, functional dyspepsia, and chronic viral hepatitis. Elderly, divorced/widowed, poor sleep quality, and lower BMI are associated with higher risk of depression and anxiety.

Mechanism of counterattack of colorectal cancer cell by Fas/Fas ligand system.

AIM: To determine the role of Fas/Fas ligand (FasL) in the immune escape of colon cancer cells. METHODS: Immunohistochemistry was used to observe the expression of Fas and FasL in the tissues of colon cancer patients. In situ hybridization was used to detect the localization of FasL mRNA expression in cancer tissues. Terminal deoxynucleotide transferase-mediated dUTP nick end labeling (TUNEL) assay and CD45 staining were performed to detect the apoptosis of tumor-infiltrating lymphocytes (TILs). Co-culture assays of colon cancer cells (SW480) and Jurkat cells (Fas-sensitive cells) were performed to observe the counterattack of colon cancer cells to lymphocytes. RESULTS: Of 53 cases of colon carcinomas, 23 cases (43.4%) expressed Fas which was significantly lower as compared to the normal colonic mucosa (73.3%, P<0.01), and 45 cases (84.9%) of colon carcinomas expressed FasL, whereas only two cases (3.75%) in normal mucosa expressed FasL. FasL expression in the colon cancer cells was found to be associated with increased cell death of TILs. The apoptotic rate of TIL in the FasL-positive staining regions of tumor cells was significantly higher than that in the FasL-negative staining region (54.84+/-2.79% vs 25.73+/-1.98%, P<0.01). The co-culture of SW480 cells and Jurkat cells confirmed the function of FasL on the SW480 cells. The apoptotic rates of Jurkat cells were found to be related with the amount of SW480 cells. CONCLUSION: Colon cancer cells can escape the immune surveillance and killing via decreasing Fas expression, and can counterattack the immune system via increasing FasL expression. Fas/FasL can serve as potential targets for effective antitumor therapy.