Aloe vera has shown extensive actions, such as anti-tumor, anti-inflammation, anti-bacteria, enhancing immune function, and anti-gastric mucosal lesion. It may be widely developed as medical products.

AIM: To study the effect of garlicin on protecting nonalcoholic fat liver in rats induced by high fat diet and explore the pathogenesis involved. METHODS: According to the dosage of garlicin and diet, fifty SD rats were randomly divided into five equal groups: normal control group, model control group and garlicin (10, 20, 30 mg/kg) groups. Apart from the rats in normal control group, the rats were all fed with high fat and high cholesterol diet. After 12 weeks, the levels of serum endotoxin (ETX), total cholesterols (TC), triglyceride (TG), superoxide dismutase (SOD), malondialdehyde (MDA), transaminase and free fatty acids (FFA) were detected. The levels of MDA, SOD, glutathione hormone (GSH) in hepatic tissue were also detected. Then the features of live pathology were observed. RESULTS: The levels of ETX, TC and TG in garlicin groups were significantly lower than those in model control group (P

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) for submucosal tumors in upper gastrointestinal tract, and its influence on choice of endoscopic therapies. Methods A total of 82 submucosal tumors from upper gastrointestinal tract were examined by EUS, and treated by various endoscopic therapeutic techniques including fulguration with high frequency current ( FHFC), endoscopic mucosal resection (EMR) and endoscopic band ligation according to orion, size and property of the lesion. The diagnoses of 58 reseeted samples were determined by routine pathological examination and immunohistochemistry. All patients were followed up with routine endoscopy and EUS. Results FHFC was applied in 26 lesions originated from muscularis mucosa, EMR was used in 17 flat lesions originated from muscularis mucosa, and endoscopic band ligation in 38 lesions from muscularis propria and 1 tumor from muscularis mucosa. The diagnostic accuracy of EUS was 91.4% (53/58). Except for post-operative bleeding in 1 patient, no other complications were observed. A total of 79 cases were followed up for 3-24 months, and no recurrence was found. Conclusion EUS can display the origin and property of submucosal tumors in upper gastrointestinal tract and guide the selection of endoscopic therapy, which is effective and safe in treatment of submucosal tumor in upper gastrointestinal tract.

Objective To investigate the risk factors of standard selectivity biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) for patints with choledocholithiasis,and the effect and safety of assistant cannulation methods.Methods The clinical data were retrospectively analyzed in 372 patients,who received ERCP for choledocholithiasis in the Yijishan Hospital of Wannan Medical College from January 2014 to December 2014.The risk factors of standard biliary cannulation were assessed by univariate and multivariate logistic regression analysis.The success rate of assistant biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) of standard biliary cannulation were compared with doubleguide wire technique (DGT) and precut sphincterotomy (PS),which were used when standard biliary cannulation failed.Results The univariate analysis showed that floppy and long duodenal papilla (P=0.000),angulated common bile duct(P=0.013) were related to failure of standard biliary cannulation.Multivariate analysis showed that floppy and long papilla (P=0.000,OR=0.131,95％CI:0.056-0.307),angulated common bile duct (P =0.003,OR =0.378,95 ％ CI:0.197-0.726) were independent risk factors for standard biliary cannulation.The success rate of standard biliary cannulation was 83.3％ (310/372),62 cases undergone DGT or PS after standard biliary cannulation failure,and the total success rate of cannulation was 99.7％ (371/372).There were 29 cases suffered from PEP in 371 successful cases of biliary cannulation,including 18 cases (5.8％,18/310) of standard biliary cannulation,8 cases (16.3％,8/49) of DGT,and 3 cases (25.0％,3/12) of PS.The incidence of PEP by DGT (x2 =5.532,P =0.019) and PS (x2 =6.994,P=0.008) was significantly higher than that of standard biliary cannulation,but there was no statistical difference on the incidence of PEP between DGT and PS (x2 =0.079,P =0.778).Conclusion Floppy and long duodenal papilla and angulated common bile duct could easily induce the failure of standard biliary cannulation in ERCP for patients with choledocholithiasis.DGT and PS are effective assistant cannulation methods when the standard cannulation fails.

Human herpesvirus-6 (HHV-6) is a ubiquitous virus. The incidence of HHV-6 after liver transplantation is estimated to be 22% ? 54%; it may present with fever, hepatitis, pneumonia, encephalitis, and myelosuppression and has a poor prognosis. HHV-6(+) recipients had a mortality rate of 29%, significantly higher than that of HHV-6(?) recipients (6%). Since most infections are asymptomatic, HHV-6 monitoring is not routinely performed in clinical practice, which means clinicians often ignore the diagnosis of HHV-6 and eventually delay diagnosis and treatment. In this paper, a case of human herpesvirus 6B encephalitis after liver transplantation was retrospectively analyzed, and the literature related to this disease was reviewed to improve the understanding of this disease.

Background:Inflammatory bowel disease (IBD)is a group of chronic gastrointestinal inflammatory disease and its diagnosis depends on analysis of clinical,endoscopic and pathological characteristics. Aims:To analyze the clinical, endoscopic and pathological characteristics of IBD. Methods:Clinical,endoscopic and pathological characteristics of 99 patients with IBD [including 61 ulcerative colitis (UC)and 38 Crohn's disease (CD)]from January 2010 to April 2017 at Yijishan Hospital were retrospectively analyzed. Results:Compared with CD patients,age in UC patients was significantly increased,incidences of diarrhea,bloody stool were significantly increased while incidence of abdominal mass was significantly decreased (P < 0. 05). Extensive type UC and ileocolonic type CD were common. Proportion of patients received 5-aminosalicylic acid (5-ASA)was significantly higher in UC than in CD (90. 2% vs. 71. 1%,P = 0. 014). Two UC patients achieved remission shown by endoscopy,and endoscopic remission achieved in 3 CD patients. The main pathological features of UC were cryptic branching (57. 1%),cryptic twisting (76. 2%),cryptic atrophy (54. 8%)and cryptic irregularity (28. 6%). Ulcer was seen in 78. 9% of CD patients with active chronic inflammation (mainly lymphocyte and plasmocyte infiltration),and the detection rate of non-caseating granuloma was 15. 8% . Conclusions:UC patients are characterized with older age,diarrhea,bloody stool and higher administration rate of 5-ASA,and the endoscopic features were mucosal bleeding and ulcers. Pathological characteristics of UC were mainly cryptic architectural change and inflammatory infiltration,while those of CD were mainly segmental lesions and chronic inflammation with lymphocyte and plasmocyte infiltration and some with non-caseating granuloma.

Objective To employ image post-processing technique measuring splenic volume for evaluating the mitigation effect of end-stage liver disease patients complicated with different degrees of hypersplenism undergoing orthotopic liver transplantation .Methods For 55 end-stage liver disease patients with hypersplenism undergoing orthotopic liver transplantation ,the changes in splenic volume were measured before and after transplantation by image post-processing system Advantage Workstation 46 (AW46) and the changes of splenic thickness ,portal flow velocity and platelet counts observed during perioperative period .Results Postoperative splenic volumes of 55 recipients were (562 .90 ± 49 .16) cm3 ,significantly decreased than preoperative (850 .50 ± 77 .99) cm3 (P< 0 .05) and reduction ratio was (31 .70 ± 2 .76 )％ . Splenic thickness at different postoperative timepoints was significantly lower than that pre-operation (P< 0 .05) and stabilized at 1 month post-transplantation ; Splenic volume was positively correlated with splenic thickness ( r = 0 .78 , P < 0 .05 ) . Portal flow velocity at different postoperative timepoints increased significantly as compared with preoperative ( P < 0 .05) ,peaked at (380 .70 ± 21 .80) mm/s at 1 month post-transplantation ,declined and stabilized at 3 months post-transplantation . Platelet counts (PLT ) at different postoperative timepoints were significantly higher than those at pre-operation ( P < 0 .05 ) ,peaked (193 .40 ± 10 .36 ) × 109 /L at 2 weeks post-transplantation ,dropped and remained at 2 months post-transplantation ;Splenic volume was negatively correlated with PLT ( r = -0 .44 , P < 0 .05 ) . And hypersplenism recovery rate and recurrence rate within 10 months post-transplantation was (78 .79 ± 2 .29 )％ and (17 .75 ± 2 .31 )％ respectively .Conclusions Orthotopic liver transplantation can effectively alleviate hypersplenism for most end-stage liver diseases .Using image post-processing system ,splenic volume may be calculated and blood routine and ultrasound are simultaneously used for assessing the outcomes of liver transplantation on hypersplenism .

Objective:To summarize the clinical features of neuroblastoma (NB) with bone metastasis in infants and the prognostic factors.Methods:A retrospective analysis was performed on 32 patients aged ≤12 months who were enrolled in Beijing Children′s Hospital, Capital Medical University from January 2010 to December 2019 and had imaging findings suggesting signs of distant bone metastasis.The control group was included NB children, aged ≤12 months, who were admitted to Beijing Children′s Hospital, Capital Medical University during the same period, without signs of distant bone destruction.The clinical manifestations and auxiliary examinations of infants with bone metastasis were summarized, and the efficacy evaluation and survival analysis of infants with regular treatment and follow-up were conducted until December 31, 2020. Kaplan- Meier survival analysis was used for prognostic analysis, and Log Rank test was used for univariate prognostic analysis. Results:There were 32 NB infants with bone metastases, involving 12 males (37.5%) and 20 females (62.5%), accounting for 16.0% (32/200 cases) of infants diagnosed with NB du-ring the same period.The median age of onset was 9 (4.5-12.0) months.The main primary site included the retroperitoneal and adrenal region in 24 cases(75.0%) and mediastinum in 3 cases (9.4%). Among the 32 cases, 14 cases (43.8%) had simple bone metastasis, 19 cases (59.4%) had distant lymph nodes, 18 cases (56.3%) had bone marrow, and 3 cases (9.4%) had intracranial and meningeal metastasis.Bone metastasis mainly occurred in the skull, with 11 cases of single bone metastases and the remaining with 2 or more bone metastases.Compared with 168 NB infants without bone metastasis, the prognosis of those with bone metastasis was significantly worse [3-year overall survival(OS) rate 97.6% vs.82.7%, P=0.001]. Univariate analysis showed that the prognosis of NB children with bone marrow metastasis, meningeal and intracranial metastasis, MYCN gene amplification, and high-risk group was poor (all P<0.05). Two patients returned to the local hospital for treatment after diagnosis.A total of 30 children were recruited for efficacy evaluation and prognostic analysis.Twenty-nine children underwent surgery, of which 6 cases received surgery before chemotherapy and 23 cases received surgery after chemotherapy.One case received chemotherapy only.The mean course of chemotherapy was 6.2 (4-13) times.One case was treated with radiotherapy, 1 case was treated with Metaiodobenzylguanidine (MIBG) therapy, and 1 case was treated with stem cell transplantation.A total of 18 cases (62.1%) event-free survived, and 12 cases (40.0%) had a mean event at 7 (1.5-32.0) months.Among them, 7 cases survived and 5 cases died (16.7%). The expected 3-year event-free survival rate and OS rate were 57.1% and 82.7%, respectively. Conclusions:The most common sites of infant NB metastasis are bone and bone marrow, and the most common sites of bone metastasis are skull.Infants with bone metastasis had a worse prognosis than those without bone metastasis, and infants with bone and bone marrow metastasis had a worse prognosis than infants with single bone metastasis.

Objective:To evaluate the efficacy of comprehensive anti-cancer treatment for lung metastases after liver transplantation (LT) for hepatocellular carcinoma (HCC).Methods:From March 2012 to July 2016, A total of 36 patients with lung metastasis after LT were divided into comprehensive anti-cancer treatment group (rapamycin + radioactive I 125 seed implantation + pulmonary artery infusion chemotherapy + sorafenib, n=22) and maintenance supportive care group ( n=14). The survival profiles of two groups were evaluated. Results:No significant inter-group differences existed in preoperative basic data, tumor pathology, time of pulmonary metastatic tumor after operation and lung metastasis tumor burden.In comprehensive anti-cancer treatment group, there were partial remission ( n=3), disease stability ( n=12) and disease progression after treatment ( n=7). In maintenance supportive care group, there were disease stability ( n=3) and disease progression after treatment ( n=11). And comprehensive anti-cancer treatment was superior to maintenance supportive care ( χ2=7.901, P=0.019). The median survival time after metastasis was 23 months (95%CI: 19.68-26.32) in comprehensive anti-cancer treatment group and 7 months (95%CI: 3.33-10.67) in maintenance supportive care group; 1-year survival rate 91% and 9%, 2-year survival rate 45% and 0% and 3-year survival rate 10% and 0% respectively.The survival rate of comprehensive anti-cancer treatment group was significantly better than that of maintenance supportive care group ( P<0.001). Conclusions:Comprehensive anti-cancer treatment (rapamycin + radioactive I 125 seed implantation + pulmonary artery infusion chemotherapy + sorafenib) can improve the survival time of patients with lung metastasis after liver transplantation for HCC.

Objective To develop a new model for predicting recurrence after liver transplantation for hepatocellular carcinoma (HCC) beyond Milan criteria based on related preoperative and postoperative indicators. Methods A retrospective analysis was performed for the clinical data of the patients with HCC beyond Milan criteria who underwent orthotopic liver transplantation for the first time in Tianjin First Central Hospital from August 2014 to July 2018, and according to the presence or absence of recurrence during follow-up, the patients were divided into recurrence group and no-recurrence group. The t -test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison of survival curves. Univariate and multivariate Cox proportional hazards regression analyses were used to identify the risk factors for recurrence-free survival after surgery. A new model was developed for recurrence after liver transplantation in the patients with HCC beyond Milan criteria based on the risk factors identified. The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive performance, and the Hosmer-Lemeshow test was used to assess the goodness of fit of the model. Results A total of 117 patients with HCC beyond Milan criteria were enrolled in this study, with a median follow-up time of 24 (1-74) months. A total of 53 patients (45.3%) experienced recurrence after surgery, among whom 52 (98.1%) had recurrence within 3 years after surgery, with a median time to recurrence of 6 (1-52) months. The Cox proportional hazards regression analysis showed that preoperative serum alpha-fetoprotein (AFP) >769 ng/mL, neutrophil-lymphocyte ratio (NLR) >3.75, and ki67 index >0.25 were independent risk factors for recurrence-free survival after liver transplantation. The model established based on these three risk factors had an AUC of 0.843, with good sensitivity (88.7%) and specificity (70.3%). The optimal cut-off value was selected according to the maximization of Youden index, and then the patients were divided into low-risk group (0-1 point) and high-risk group (1.5-4 points). The log-rank test showed that the low-risk group had significantly higher 3-and 5-year recurrence-free survival rates than the high-risk group (84.1%/72.0% vs 10.9%/10.9%, χ 2 =29.425, P < 0.001). Conclusion Liver transplantation for HCC beyond Milan criteria should be performed with caution, and the predictive model established based on preoperative AFP, NLR, and ki67 index can accurately assess the indication for liver transplantation in such patients.