Objective This study aimed at assessing the long-term efficacy of EVL for esophageal variceal bleeding. Methods Long-term EVL was assessed in 263 patients with variceal bleeding,among them 71 were of Child- Pugh Class A,82 of Class B and 110 of Class C.EVL was repeated at two week intervals until varices were eradicated.Results Esophageal varices were eradicated in 91% of the 238 patients who survived for more than three months after 1 to 10 (average 4) successive ligations.Recurrent variceal bleeding occurred in 15% of the 263 patients and was markedly reduced after eradication of the varices.The overall cumulative survival rates at 1,3,and 5 years were 76%,62%,and 57%,respectively.The prognosis was influenced by Child- Pugh's risk grade.56 of the 263 patients died during the study period,and the major cause of death was liver failure.Conclusion EVL is effective for long-term control of esophageal variceal bleeding.Repeated EVL re- duces rebleeding rate and improves survival in patients who have bled from esophageal varices.

BACKGROUND:Human amniotic epithelial cells(AECs)are easy to obtain and can function as ideal seed cells for cell transplantation and tissue repair.Currently,marking and tracing of human AECs remains rarely reported.OBJECTIVE:To explore the efficiency of adeno-associated virus(AAV)vector-medicated green fluorescent protein(GFP)on in vitro cultured human AECs transfection.METHODS:Human amnion samples were harvested and trypsinized to isolate human AECs.The AECs were transfected with AAV-GFP,and the transfection efficiency was detected.RESULTS AND CONCLUSION:Human AECs were successfully primary cultured and passaged in vitro.AAV-GFP-transfected AECs stably and highly expressed GFP,with a transfection efficiency of 58%.

Objective To probe the effects of recombinant adenovirus containing Akt on carbon tetrachioride-induced rat liver cirrhosis and portal hypertension. Methods Cirrhosis was induced in rats by a complex method of carbon tetrachloride. Recombinant adenovirus Ad-myr-HA-Akt was produced by homologous recombination in 293 cells. Rats received Ad-myr-HA-Akt via the tail vein at the second and the sixth week respectively. The pathological changes in liver tissues were observed after Van Gieson (VG) staining. Fas antigen in rat livers were determined by immunohistochemical method. The levels of alanine minotransferase( ALT), aspartate aminotransferase ( AST), albumin( ALB ) and hydroxyproline (Hyp) were measured. Fas antigen in rat livers were determined with immunohistochemical method. Expression of Akt, p-Akt, Fas and DR5 were evaluated by Western blotting. Frozen sections of the liver, heart,lung,kidney, brain,spleen and testis were made to examine the expression of enhance green flourescent protein (EGFP) by fluorescence microscopy in EGFP group. After 8-week CCl4 treatment, portal hypertensive rats in the saline group and Ad-Akt group received saline and Ad-myr-HA-Akt via the tail vein respectively. Portal vein pressure, mean arterial pressure and heart rate were measured in all rats on Day 3. Results In comparison with other cirrhosis rats, the pathological changes in the Akt group was markedly attenuated, and the levels of ALT, AST and Hyp were significantly lowered. Western blotting showed that the protein expression of p-Akt in the Akt group was higher significantly as compared with those in the negtive control group, saline group and EGFP group. Western blot also showed that the protein expression of Fas and DR5 in the Akt group was lower significantly. EGFP expression was mainly demonstrated by fluorescence microscopy on the frozen section of liver, very little fluorescene were detected in lung and kidney and there was no detectable EGFP in the other organs. Conclusions Ad-myr-HA-Ak inhibits CCl4-induced liver cirrhosis and is a potential pharmacological target for gene therapy in liver cirrhosis.

Objective To evaluate the in vitro differentiation of human amniotic epithelial cells (hAECs ) into hepatocyte-like cells. Methods Combined approach of dexamethasone, HGF, IGF and other cytokines were used to induce the differentiation of hAECs into hepatocyte-like cells. The induction lasted 2 weeks. During the induction, the expression of albumin ALB, CYP1A1, CYP1A2, IGFR, c-met and key functional genes related to liver cells as well as transcription factors HNF3, HNF4 and C/EBPa were monitored by RT-PCR. Time dependent changes of the surface marker colony ALB, AFP and CK18 were analyzed by cell flow cytometry. Results After the 2 week induction, the expressions of liver hepatocyte-like cell functional genes such as albumin, CYP1A1, CYP1A2, c-met, and transcription factors such as HNF3, HNF4, C/EBPa and HNF1 were observed. Six days after the induction, hAECs mainly were stained AFP+, and the positive rate was (15.1±2.1)%. While 10 days after the induction, part of the hAECs showed AFP+/ALB+ (6.5±1.4)%; and on 14th day, hAECs only showed ALB+, and the rate was (13.9±2.3)%. ALB+ cell increase indicated a gradual functional maturation from the hAECs to hepatocyte-like cells. Similaritly, the number of CK18+ cells in the whole population was also increased: On 10th day, the rate was (16.1±1.2)%; on 14th day, that was (21.3±4.6)%, which proved the above hypothesis of the trandifferentiation. By extending the induction time, the expression of functional genes increased gradually, and a maturing process of hAECs was detected by cell surface markers. Conclusion The differentiation of hAECs induced in vitro has the characteristics of hepatocyte-like cells.

Objective To assess the effect of different treatment complex on portoazygous shunt in portal hypertensive patients. Methods Patients (115 cases) with esophageal varices were randomized to receive either endoscopic variceal ligation ( EVL) alone (54 cases ) , pericardial devascularization procedure (PDP) alone(30 cases) or a combination of EVL and PDP(31 cases) for variceal eradication. Esophageal vascular structures were examined with miniature ultrasonic probe and azygos blood flow (ABF) was measured with color Doppler ultrasonography. Results Esophageal varices were obliterated and collateral veins remained unchanged in patients treated by EVL, esophageal varices were diminished in size and collateral veins were obliterated by PDP and both esophageal varices and collateral veins were obliterated by the combination of EVL and PDP. EVL,PDP alone and a combination of the two modalities decreased ABF by 31% ,32% and 43% respectively. Conclusions The combination of EVL and PDP most effectively blocks esophageal collateral shunts.

Objective To assess the efficacy of endoscopic variceal ligation (EVL) combined with Hassab 's procedure in the prevention of variceal recurrence. Methods One hundred and thirty-five patients with esophageal varices were randomized to receive EVL alone, Hassab's procedure alone or a combination of EVL and Hassab's procedure for variceal eradication. Ultrasonographic venous network images were recorded by an esophageal microprobe before and after the EVL or Hassab 's procedure. The clinical outcome and vascular network images of the 3 groups were analyzed. Results Esophageal varices were obliterated immediately after EVL alone, while both perforating veins and periesophageal collaterals remained patent, and 83% had recurrence of esophageal varices during an initial 3-year follow-up. Esophageal varices were reduced in size, periesophageal collaterals were obliterated after Hassab's procedure alone, and 30% experienced rebleeding and 95% with variceal recurrence. EVL combined with Hassab 's procedure obliterated all esophageal varices, perforating veins and periesophageal collaterals, and only 3 patients (8% ) recurred. Conclusion The existence of patent perforating veins and periesophageal collaterals is the reason of esophageal variceal recurrence after EVL alone. EVL combined with Hassab 's procedure can effectively prevent the recurrence, even if the cirrhotic portal hypertension persisted.

OBJECTIVECombined the optical principle with automatic control technology and computer real-time image detection technology to develop a non-contact system for noninvasive esophageal varices pressure measurement.

METHODSThe system included the adjustable air pump, laser device, image collection and analysis program. The feasibility and accuracy of the system were verified by in vitro experiments.

RESULTSThe bionic vascular pressure measured by this system had good correlation and repeatability with the actual pressure.

CONCLUSIONSThis system is accurate, feasible and has good application prospects.

Objective To study the role of VEGF in the development of portal hypertensive gastropathy(PHG). Methods Forty-four portal hepertensive patients were investigated according to with or without PHG. The degree and the location of PHG were recorded. The specimens were obtained to perform RT-PCR to measure VEGF mRNA. Results VEGF mRNA in severe (3.48?1.02) or moderate PHG (2.28?0.33) with portal hypertension was higher than that in control (1.40?0.23) and those (1.51?0.32) with portal hypertension without PHG( P

OBJECTIVE: To determine the therapeutic effect of laparoscopic splenectomy, perisoph-agogastric devascularization, and endoscopic variceal ligation (EVL) on patients with portal hypertension. METHODS: We randomly divided 105 patients into 3 groups: 40 had endoscopic band ligation (the ligation group), 35 had splenectomy and perisoph-agogastric devascularization (the laparotomy group), and the other 30 had laparoscopic splenectomy, perisoph-agogastric devascularization and endoscopic variceal ligation (the combination group). Blood samples were analyzed preoperatively and postoperatively on day 1,3,and 7,including alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),and directed bilirubin(DBIL). The length of stay, blood loss, operation time, anal exhaust time, azygos vein diameter, blood flow velocity and blood flow, recurrence of esophageal varices and rehaemorrhagia were compared. RESULTS: Between the combination group and the laparotomy group, the serum levels of TbIL and Dbil had difference on 1st postoperative day(P<0.05). AST had difference on 7th postoperative day(P<0.05). The length of stay, blood loss, operation time, and anal exhaust time had significant difference(P<0.05). Among the combination group, the laparotomy group and the ligation group, the azygos vein blood flow before and after the treatment, recurrence of esophageal varices and rehaemorrhagia had no difference(P<0.05). CONCLUSION Laparoscopic splenectomy, perisoph-agogastric devascularization and endoscopic variceal ligation have less trauma, lower recurrence rate, fewer complications and rapid recovery, and may reduce the azygous vein blood flow. It can be used safely for portal hypertension.
Adult ; Endoscopy ; methods ; Esophageal and Gastric Varices ; complications ; surgery ; Female ; Humans ; Hypertension, Portal ; complications ; surgery ; Laparoscopy ; methods ; Ligation ; methods ; Male ; Middle Aged ; Splenectomy ; methods

A new device that allows noninvasive measurement of venous pressure has been invented in our laboratory and tested for its feasibility and validity. The device consists of four parts: 1. the air infusion system; 2. the pressure sensor gauge; 3. signal transducer and data processing system 4. the fixing apparatus. The correlation between noninvasive pressure and invasive pressure has been studied in vitro test on a saphenous vein model and in vitro test on dog's portal venous system. In vitro and vivo study, an excellent correlation between noninvasive pressure and invasive pressure was obtained(r = 0.99, P < 0.0005; r = 0.97, P < 0.005). These data suggest that the new device allows a noninvasive measurement of venous pressure especially for the large veins such as vena cava, venae pulmonales and esophageal varices.
Animals ; Blood Pressure Determination ; instrumentation ; Dogs ; Equipment Design ; In Vitro Techniques ; Venous Pressure ; physiology