Objective:To study the clinical effect and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of liver cirrhosis with esophageal variceal bleeding.Methods:86 cases of cirrhotic patients with esophageal and gastric varices bleeding admitted in our hospital from August 2013 to April 2015 were selected and randomly divided into the control group and the observation group with 43 cases in each group.The control group underwent percutaneous transhepatic coronary vein embolization (PTVE) treatment,while the observation group were treated with TIPS.The success rate of surgery,the incidence of various complications,the long-term survival rate and the symptoms and the changes of liver function after operation were compared between the two groups of patients.Results:The portal vein pressure after operation in the observation group was significantly lower than that of the control group (P=0.00),at 3 months,6 months and 12 months after operation,the rebleeding rate in the observation group were significantly lower than that of the control group (P＜0.05),but the incidence of hepatic encephalopathy showed no significant difference between the two groups (P＞0.05);before operation and at 6 months and 12 months after operation,the Child-Pugh score,serum TBIL,DBIL levels showed no significant difference between the two groups (P＞0.05),at 3 months after operation,the Child-Pugh score,serum TBIL,DBIL levels in the observation group were significantly higher than those of the control group (P＜0.01);the 1 year survival rate showed no significant difference between two groups (P=0.72).Conclusion:TIPS could effectively improve the symptoms of varicose veins,better on liver function damage,and enhance the long-term survival high rate with high safely in the treatment of esophageal variceal bleeding in patients with cirrhosis.

ABSTRACT:Objective To observe the influence of saikosaponin-d (SSd)on the proliferation and the function of autophagy of human hepatocellular carcinoma (HCC)cell line SMMC-7721 to explore the possible mechanisms. Methods SMMC-7721 was cultured invitro and then treated with SSd of various concentrations (5.0,7.5,10.0, 12.5,15.0 and 17.5 mg/L)for 24,48 and 72 h.We used MTT to detect cell proliferation,selected the optimal concentration and time,and detected the expressions of BECN1 at mRNA and protein levels by PCR and Western blot.Results The inhibition rate of the proliferation of SMMC-7721 cell line increased with the increase of the concentration of SSd,and the highest inhibition rate (60%)appeared when the concentration reached 12.5 mg/L. The expression of BECN1 in the group with SSd was obviously higher than that in the control group (P<0.05). 3-MA decreased not only the expressions of BECN1 at mRNA and protein levels but also the expression of BECN1 when used in conjunction with SSd.Conclusion The inhibiting function of SSd on SMMC-7721 presents a dependency between drug concentration and function time,basically in line with the drug dose-effect relationship. SSd induces the occurrence of autophagic cell death through up-regulating the expression of BECN1 ,thus inhibiting the proliferation of SMMC-7 7 2 1 .

Objective To investigate the display status of ultrasonography imaging check in central nervous system (CNS) in infants of early pregnancy and the diagnostic value of CNS malformation in infants of early pregnancy.Methods Gestational weeks of 2 751 enrolled subjects were divided according to the ultrasonic measurement of the crown rump length (CRL):11-11 +6 weeks group,12-12+6 weeks group,and 13-13 + 6 weeks group,prenatal ultrasound were performed to examine fetal CNS anatomy in infants of early pregnancy,record the display status in each groups of infants and analyze the relationship between the display situation and gestational age.Results Fourteen cases of fetal CNS malformation (20 malformations) in total were found by prenatal ultrasound,and the incidence of CNS malformation was about 5.09％ (14/2 571).Wherein,12 cases of early pregnancy were diagnosed,and 2 cases of middle pregnancy were diagnosed.The sensitivity of ultrasound of early pregnancy in the diagnosis of fetal CNS malformation was 85.71％.In the group of research,the ultrasound display ratios of 11-11+6 weeks group,12-12+6 weeks group and 13-13+6 weeks group were 96.73％,97.94％,98.06％,respectively.There was no significant difference in early pregnancy fetal CNS display ratio among groups (x2 =1.56,v =2,x2＜ x0.05.2 =5.99,P ＞ 0.05).Conclusions The display rate of CNS structure in infants of early pregnancy (11-13+6 weeks)is higher,and is not affected by gestational weeks.Prenatal ultrasound can effectively diagnose CNS severe malformation in infants of early pregnancy.

Objective To investigate the expression of DNA methyltransferase 3b (DNMT3B) in hepatocellular carcinoma (HCC) and its effect and mechanism on the proliferation,invasion and migration of HCC cells.Methods The expression of DNMT3B gene was detected by qRT-PCR in 46 cases of HCC tissues and corresponding adjacent tissues;the results and clinical pathological parameters were analyzed.SiRNA targeting DNMT3B was transfected into MHCC97-H cells by RNA interference (RNAi) technique.The mRNA and protein expression levels of related genes were detected by qRT-PCR and Western blot.The cell proliferation was measured by MTT assay,and the invasion and migration abilities were measured by Transwell assay.Results In 46 HCC patients,the expression of DNMT3B (73.91％) was significantly higher in HCC than in adjacent normal tissue.The high expression of DNMT3B gene was associated with histological type and tumor size of HCC (all P＜0.05).Inhibition of DNMT3B gene expression decreased proliferation,invasion and migration of MHCC97-H cells.Interference with DNMT3B gene increased the expressions of tumor suppressor genes RASSFA1,APC and MTSS1 at mRNA and protein levels.Conclusion DNMT3B is associated with the progression of HCC.It may inhibit the proliferation,invasion and migration of HCC cells by regulating the methylation of downstream tumor suppressor gene.

Objective:To explore the expression of polypyrimidine tract-binding protein 1 (PTBP1) in gastric cancer (GC) tissues and GC cell lines, and the role of PTBP1 in the proliferation and metastasis of GC cells.Methods:From January to June in 2019 at The First Affiliated Hospital of Xi′an Jiaotong University, the cancer tissues and corresponding para-cancer tissues of GC patients underwent surgical resection were collected. The Kaplan-Meier Plotter database was used to analyze the survival of GC patients. The expression of PTBP1 was down-regulated by transfecting small interfering RNA (siRNA) in human GC cell lines SGC7901 and AGS with relatively high expression of PTBP1. The cells were divided into blank control group, negative control group, and PTBP1 knockdown group. The expression of PTBP1 at mRNA and protein level were detected by real-time fluorescence quantification polymerase chain reaction (RT-qPCR) and Western blotting. At 24, 48, 72 and 96-hour after transfection, the effect of PTBP1 on the proliferation of GC cells was observed by 3-(4, 5 dimethylthiazol)-2, 5 diphenyltetrazolium bromide (MTT) experiment. The changes of invasion and migration of GC cells after down-regulation of PTBP1 were detected by transwell assay. The expression changes of epithelial-mesenchymal transition (EMT) markers E-cadherin, N-cadherin and vimentin after down-regulation of PTBP1 in GC cells were determined by Western blotting. Indenpendent samples t test, analysis of variance and rank sum test were used for statistical analysis. Results:The Kaplan-Meier Plotter prognostic analysis showed that the overall survival of GC patients with high PTBP1 expression was shorter than that of GC patients with low PTBP1 expression (9.2 months, 6.2 months to 17.2 months vs. 19.0 months, 14.5 months to 28.4 months), and the difference was statistically significant ( Z=5.31, P<0.05). The results of RT-qPCR showed that in GC cell lines SGC7901 and AGS, the expression of PTBP1 at mRNA level of PTBP1 knockdown group was lower than that of blank control group and negative control group (SGC7901: 0.78±0.11 vs.3.10±0.19 and 2.99±0.23; AGS: 0.80±0.09 vs. 3.55±0.24 and 3.50±0.18), and the differences were statistically significant ( tSGC7901=10.57 and 8.08, tAGS=10.91 and 13.42; all P<0.01). The results of Western blotting indicated that in GC cell lines SGC7901 and AGS, the expression of PTBP1 at protein level of PTBP1 knockdown group was lower than those of blank control group and negative control group (SGC7901: 0.38±0.04 vs. 1.42±0.05 and 1.35±0.09; AGS: 0.17±0.02 vs. 1.52±0.08 and 1.38±0.45), and the differences were statistically significant ( tSGC7901=15.94 and 10.57, tAGS=16.60 and 20.80; all P<0.01). The results of MTT showed that at 48, 72 and 96-hour after transfection the absorbance values of PTBP1 knockdown group decreased by 0.25±0.01, 0.38±0.02, and 0.84±0.04 as compared with those of negative control group, and the decrease was the most significant at 96-hour after transfection, and the differences were statistically significant ( t=10.21、14.32, both P<0.01). The results of transwell experiment demonstrated that the number of invasion and migration cells of PTBP1 knockdown group were both less than that of the blank control group and the negative control group (SGC7901: 42.00±5.91 vs. 116.40±10.23 and 114.40±10.43; 39.60±6.77 vs. 125.80±11.51 and 122.40±5.90; AGS: 40.20±7.25 vs. 115.60±14.63 and 117.40±9.12; 36.00±5.20 vs. 122.40±12.10 and 125.40±12.74), and the differences were statistically significant ( tSGC7901=14.07, 13.50, 14.43 and 20.62; tAGS=10.27, 14.75, 14.68 and 16.76; all P<0.01). The results of Western blotting showed that the expression of E-cadherin of PTBP1 knockdown group was higher than that of the blank control group and the negative control group (SGC7901: 1.42±0.05 vs. 0.53±0.05 and 0.57±0.03; AGS: 1.34±0.04 vs. 0.54±0.03 and 0.61±0.01), however the expression levels of N-cadherin and vimentin were both lower than those of the blank control group and the negative control group (SGC7901: 0.50±0.03 vs. 1.64±0.05 and 1.46±0.07; 0.32±0.07 vs. 1.42±0.07 and 1.33±0.07; AGS: 0.37±0.06 vs. 1.47±0.04 and 1.36±0.04; 0.41±0.04 vs. 1.53±0.06 and 1.37±0.04), and the differences were statistically significant ( tSGC7901=11.63, 13.19, 18.83, 11.68, 11.43 and 10.43; tAGS= 15.02, 16.23, 14.67, 12.97, 14.45 and 17.18; all P<0.01). Conclusions:The expression levels of PTBP1 increase in GC tissues and cells, which may be involved in regulating the proliferation, metastasis and EMT of GC cells.

Objective To detect the expression profile of transcription factor C/EBPβ in human immortalized normal hepatic cell lines and hepatocellular carcinoma cell lines so as to determine the correlation between C/EBP3 with cell death mediated by endoplasmic reticulum stress in hepatocellular cells.Methods We cultured the human immortalized normal hepatic cells lines HHL5 and HL7702 and hepatocellular carcinoma cell lines SMMC7721;Bel7402,HepG2 and Hep3B.Hep3B cells were used as the cell model in tunicamycin-induced endoplasmic reticulum stress.Cellular morphology was observed under an inverted optical microscope.MTT assay was used to assess the inhibition of cell growth.To detect cell apoptosis,the cells were dyed with Hoechst 33258 and observed using a fluorescence microscope.RToPCR and Western blotting were used to detect the expression of at mRNA and protein levels,respectively.Results We found that normally the mRNA and protein isoform of C/EBPβ,C/EBPβ-1,were both expressed in all of the four hepatocellular cell lines and the two immortalized normal hepatic cell lines,while C/EBPβ protein isoform C/EBPβ-3 was only expressed in the two immortalized normal hepatic cell lines.Tunicamycin increased the expressions of both mRNA and protein of C/EBPβ in Hep3B cells and the increase of protein isoform C/EBPβ-3 was the most remarkable.In Hep3B cells,cell death was induced by tunicamycin through endoplasmic reticulum stress activity.Apoptosis as well as paraptosis was observed in tunicamycin-induced cell death.Conclusion C/EBPβ-3,one of the protein isoforms of C/EBPβ,is only expressed in normal hepatic cell lines,but not in hepatocellular cell lines.C/EBPβ is involved in cell death mediated by endoplasmic reticulum stress activity in hepatocellular carcinoma cells.

OBJECTIVE: To compare the efficacy and safety of combined radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA alone for hepatocellular carcinomas (HCC). MATERIALS AND METHODS: Randomized controlled trial (RCT) studies that compared the clinical or oncologic outcomes of combination therapy of TACE and RFA versus RFA for the treatment of HCC were identified through literature searches of electronic databases (Pubmed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, and Google Scholar). Hazard ratios (HRs) or odds ratios (ORs) with their corresponding 95% confidence interval (CI) were combined as the effective value to assess the summary effects. The strength of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: Six RCTs with 534 patients were eligible for inclusion in this meta-analysis. The meta-analysis showed that the combination of TACE and RFA is associated with a significantly longer overall survival (HR = 0.62, 95% CI: 0.49-0.78, p < 0.001) and recurrence-free survival (HR = 0.55, 95% CI: 0.40-0.76, p < 0.001) in contrast with RFA monotherapy. The seemingly higher incidence of major complications in the combination group compared with RFA group did not reach statistical significance (OR = 1.17, 95% CI: 0.39-3.55, p = 0.78). CONCLUSION: In patients with HCC, the combination of TACE and RFA is associated with significantly higher overall survival and recurrence-free survival, as compared with RFA monotherapy, without significant difference in major complications.
Carcinoma, Hepatocellular/*surgery ; Catheter Ablation/adverse effects/*methods ; Chemoembolization, Therapeutic/adverse effects/*methods ; China ; Combined Modality Therapy ; Disease-Free Survival ; Humans ; Liver Neoplasms/*surgery ; Odds Ratio ; Proportional Hazards Models ; Treatment Outcome

Objective:To evaluate the feasibility and effectiveness of magnetic anchor-guided endoscopic submucosal dissection (MAG-ESD).Methods:A total of 36 patients with gastrointestinal tumors at different sites who underwent MAG-ESD in the First Affiliated Hospital of Xi'an Jiaotong University from March 2020 to October 2022 were enrolled. The anchor success rate, en bloc resection rate, the anchor time, the procedure time, and the complication incidence were observed and analyzed.Results:Among the 36 patients, there were 9 lesions in stomach, 2 in duodenum, 6 in cecum and 19 in colorectum. Thirty-five (97.2%) patients successfully underwent magnetic anchor, and en bloc resection of lesions were completed. No adverse events such as bleeding or perforation occurred. The anchor time and procedure time was 4.0 (2.0-9.5) min and 36 (16-82) min, respectively.Conclusion:MAG-ESD is feasible and effective for gastrointestinal tumors at different sites, with a high anchor success rate and en bloc resection rate, and shorter operation time, especially for difficult submucosal dissection.

Clinical cases treated by magnetic compression anastomosis (MCA) for different causes and types of intestinal stenosis/ atresia to successfully achieve intestinal recanalization were reviewed, so as to explore the clinical application of MCA. From May 2019 to August 2022, 4 patients underwent colorectal MCA for intestinal recanalization in the First Affiliated Hospital of Xi'an Jiaotong University and Northwest Women and Children's Hospital. All operations went well, and the intestinal anastomosis was recanalized. The magnetic ring was discharged in 7-15 days, and the postoperative colonoscopy or radiography showed that the anastomosis was intact. MCA can be used to treat different types of colorectal stenosis and atresia due to different reasons, and can also be used to assist intestinal anastomosis in colorectal surgery.

【Objective】 To investigate the outcomes of intravenous injection of human albumin (HA) in patients with both liver cirrhosis and nephrotic syndrome. 【Methods】 We retrospectively studied 101 liver cirrhosis patients with ascites and nephrotic syndrome treated in our hospital from January 2018 to November 2021. All the patients received oral diuretic and intravenous albumin therapy. Their baseline characteristics were collected and the changes in serum albumin and creatinine levels before and after treatment were evaluated. The patients with elevated albumin levels after treatment greater than the median value (1.8 g/L) were defined as response group. The rest of the patients were classified as the non-response group. And Logistic regression analysis was used to evaluate the relevant influencing factors for treatment response. 【Results】 All the patients’ symptoms of abdominal distension related to moderate to great ascites were clinically lessened at the end of treatment, and no case of acute kidney injury occurred during the treatment. Of them, 32 patients had repeated hospitalizations within six months after discharge. The serum albumin level was significantly increased after treatment [(26.5±5.9) g/L vs. (29.9±4.9) g/L, P<0.001] and there was no significant difference in serum creatinine before and after treatment [(111.9±118.4)μmol/L vs. (108.5±87.9)μmol/L, P=0.816]. Fifty-three patients were defined as treatment response group. The differences in characteristics including age, sex, etiology of cirrhosis, and proteinuria were not statistically significant. However, the serum creatinine level was significantly lower in the response group than in the non-response group [(84.1±51.2)μmol/L vs. (142.7±158.4)μmol/L, P=0.017\]. A similar trend of difference was observed with respect to urea nitrogen level \[(8.7±5.1)mmol/L vs. (11.8±9.1)mmol/L, P=0.039\]. Multivariate analyses demonstrated that the serum creatinine level was a risk factor for non-response to treatment (hazard ratio=1.025, 95% CI: 1.010-1.049, P=0.037). In addition, the correlation analysis showed that the baseline albumin levels were negatively correlated with hospital stay time (r=-0.340, P=0.001), daily HA usage (r=-0.546, P<0.001), and baseline proteinuria levels (r=-0.654, P<0.001), respectively. 【Conclusion】 Intravenous injection of HA in cirrhotic patients with nephrotic syndrome was safe and effective for the treatment of ascites. Kidney function affects serum albumin levels and response to treatment.