Esophageal variceal bleeding is a common complication of liver cirrhosis. Non-selective beta blockers (NSBB) have been established in numerous studies as one of the medical treatment for cirrhosis, especially in the primary and secondary prevention of variceal bleeding. The dose of NSBB is adjusted for a reduction in the resting heart rate by 25%, to 55 beat/min, or until the occurrence of adverse effect. The mean adjusted dose of propranolol in Korean study is 160 mg/day. Nevertheless, low dose propranolol is frequently used in real clinical field. A study by Kwon et al. showed that effect of propranolol in the prevention for esophageal rebleeding was superior in maximally-tolerable dose group of propranolol than low dose group. In this editorial, we have reviewed the studies of prevention for variceal rebleeding focusing on the dose of propranolol.
Esophageal and Gastric Varices ; Fibrosis ; Heart Rate ; Liver Cirrhosis ; Propranolol* ; Secondary Prevention

Calcium ; metabolism ; Growth Substances ; metabolism ; Humans ; Pulmonary Fibrosis ; drug therapy ; metabolism ; prevention & control ; Taurine ; therapeutic use

Animals ; Diabetes Mellitus, Experimental/drug therapy* ; Fibrosis/prevention & control* ; Hyperglycemia/prevention & control* ; Hypoglycemic Agents/pharmacology* ; Inflammation/prevention & control* ; Male ; Rats ; Rats, Sprague-Dawley ; Stilbenes/pharmacology*

OBJECTIVETo investigate diagnosis and treatment of abdominal cocoon.

METHODSClinical data of patients received treatment for abdominal cocoon from January 2000 to January 2011 was retrospectively analyzed.

RESULTSA total of 67 patients underwent treatment in our hospital were analyzed, the preoperatively diagnosis rate was only 47.8% (32/67). Patients who received preoperatively nutrition support have a lower postoperative complication (8/27 vs.13/20, χ(2) = 5.815, P < 0.05) and patients with less extent of intestine involved had a lower early postoperative inflammatory ileus (EPII) rate (9/25 vs. 1/22, χ(2) = 6.912, P < 0.05) when compared with large extent.

CONCLUSIONSAppropriate perioperative management play an important role in the prognosis of abdominal cocoon. The main treatment is surgery while preoperatively nutrition support can reduce postoperative complications.

Adolescent ; Adult ; Aged ; Female ; Humans ; Ileus ; prevention & control ; Male ; Middle Aged ; Peritoneal Fibrosis ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Young Adult

Myocardial fibrosis is an inevitable process of many heart diseases, such as coronary heart disease, myocardial infarction, hypertension, cardiomyopathy, etc. in development from earlier period to terminal stage. To prevent or reverse the process of fibrosis is one of the most important approaches to retard the occurrence of heart failure and reduce the accidence of arrhythmia. In traditional Chinese medicine myocardial fibrosis belongs to the category of "Xinbi". Studies on the occurrence and regulation of myocardial fibrosis, and its treatment by using integrative Chinese and Western medicine or by Chinese drugs singly and their components were reviewed in this paper.
Cardiomyopathies ; drug therapy ; prevention & control ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Fibrosis ; drug therapy ; prevention & control ; Humans ; Medicine, Chinese Traditional ; Myocardium ; pathology ; Phytotherapy

Globally, viral hepatitis due to hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection is the major cause of advanced liver diseases such as liver cirrhosis and hepatocellular carcinoma (HCC). Chronic inflammation resulting from persistent viral hepatitis is also associated with an increased risk of HCC recurrence. Replication of HBV and/or HCV can reactivate during anti-cancer treatments of HCC and lead to hepatic dysfunction, adversely affecting patient outcomes. The most effective way to prevent chronic viral hepatitis, cirrhosis, or HCC would be the implementation of a vaccine. Unfortunately, a vaccine for HCV is currently not available. For chronically infected patients, antiviral therapy may be the only option that can prevent or retard disease progression. Emerging evidence continues to support direct or indirect benefits from antiviral therapy for preventing liver disease progression to cirrhosis, HCC development, and recurrence after curative treatments in patients with chronic HBV or HCV infection. This paper reviews the literature on the management of viral hepatitis in patients with HCC, focusing on primary and tertiary prevention of HCC.
Carcinoma, Hepatocellular* ; Disease Progression ; Fibrosis ; Hepacivirus ; Hepatitis B virus ; Hepatitis* ; Humans ; Inflammation ; Liver Cirrhosis ; Liver Diseases ; Recurrence ; Tertiary Prevention

Crohn disease (CD) is a chronic inflammatory bowel disease that affects the entire gastrointestinal tract but is most frequently localized to the large and small bowel. Small bowel endoscopy helps with the differential diagnosis of CD in suspected CD patients. Early diagnosis of CD is preferable for suspected CD conditions to improve chronic inflammatory infiltrates, fibrosis. Small bowel endoscopy can help with the early detection of active disease, thus leading to early therapy before the onset of clinical symptoms of established CD. Some patients with CD have mucosal inflammatory changes not in the terminal ileum but in the proximal small bowel. Conventional ileocolonoscopy cannot detect ileal involvement proximal to the terminal ileum. Small bowel endoscopy, however, can be useful for evaluating these small bowel involvements in patients with CD. Small bowel endoscopy by endoscopic balloon dilation (EBD) enables the treatment of small bowel strictures in patients with CD. However, many practical issues still need to be addressed, such as endoscopic findings for early detection of CD, application compared with other imaging modalities, determination of the appropriate interval for endoscopic surveillance of small bowel lesions in patients with CD, and long-term prognosis after EBD.
Capsule Endoscopy ; Constriction, Pathologic ; Crohn Disease ; Diagnosis, Differential ; Early Diagnosis ; Endoscopy ; Fibrosis ; Gastrointestinal Tract ; Humans ; Ileum ; Inflammatory Bowel Diseases ; Prognosis ; Secondary Prevention

To investigate the effects of mycophenolate mofetil (MMF) on the process of renal interstitial fibrosis, unilateral ureteral obstruction (UUO) model was established in rats. Twenty Sprague-Dawley rats underwent UUO and received vehicle (n = 10) or MMF (20 mg.kg-1.d-1, by daily gastric gavage, n = 10) during a period of 5 days following surgery, and the additional 10 rats were served as sham-operated group. The rats were killed 5 days after surgery. Immunohistochemistry was performed on renal tissue for proliferating cell nuclear antigen (PCNA), alpha-smooth muscle actin (alpha-SMA) and type I and III collagen (col I, col III). Histological studies were also done by MASSON staining. Five days after surgery, proliferating cells in tubules, interstitium as well as interstitial myofibroblast (MyoF) infiltration and interstitial col I, col III deposition were all significantly reduced by MMF treatment. MMF also alleviated the histological changes of UUO rats. These results suggested that the reduction of interstitial MyoF infiltration may be an important event by which MMF prevents renal injury caused by UUO and MMF could be used to limit the progression of renal fibrosis.
Fibrosis ; Kidney/*pathology ; Kidney Diseases/etiology ; Kidney Diseases/pathology ; Kidney Diseases/*prevention & control ; Mycophenolic Acid/*analogs & derivatives ; Mycophenolic Acid/*pharmacology ; Random Allocation ; Rats, Sprague-Dawley ; Ureteral Obstruction/*complications

OBJECTIVETo investigate the prevention of esophageal varices recurrence by laser inducing esophageal mucosal fibrosis.

METHODSOur study included 42 patients after esophageal varices eradicated by endoscopic varices ligation, and they were divided into 2 groups randomly, each group included 21 patients. One group was assigned to received laser treatment, and indocyanine green solution (1 mg/ml) was injected submucosally, a diode laser (power 10 watts) was applied to the surface from the esophagogastric junction to 5 cm above it. Another group was controlling without any treatments. All patient were followed up by endoscopy every 3 months until 12 months.

RESULTSLaser irradiation was performed safely without any major complications. And lower esophageal mucosa produced fibrosis widely after laser irradiated 1 month. After 12 months follow up, the cumulative recurrence rate was significantly lower than the control group, 14% (3/21) vs 43% (9/21) (chi(2) = 4.20, P < 0.05).

CONCLUSIONSOur study indicates that laser inducing mucous fibrosis is safely and can prevent recurrence of esophageal varices.

Adult ; Esophageal and Gastric Varices ; pathology ; surgery ; Esophagoscopy ; Esophagus ; pathology ; Female ; Fibrosis ; Follow-Up Studies ; Humans ; Laser Coagulation ; methods ; Ligation ; Male ; Middle Aged ; Mucous Membrane ; pathology ; Secondary Prevention

OBJECTIVETo investigate the effect of losartan on the expression of monocyte chemoattractant protein-1 (MCP1) and transforming growth factor-β(1) (TGF-β(1)) in the kidney of rats with unilateral urethral obstruction (UUO) and evaluate protective effect of losartan against reanal interstitial fibrosis.

METHODSRat models of UUO were treated with losartan at the routine dose, high dose, and very high dose (50, 200, and 500 mg/kg daily, respectively), and saline was given to UUO model rats and rats with sham operation. At 7, 14, and 21 days, the tail cuff blood pressure (TCP), 24-h urine protein (Upro), serum Scr, BUN, K(+), percentage of renal damage and renal interstitial fibrosis (%INT) were measured in the rats. MCP1 protein in the renal tissues was detected using immunohistochemistry, and MCP1 and TGF-β(1) mRNA expressions were assayed using RT-PCR.

RESULTSAs the UUO prolonged, Upro, TCP, tubular damage, %INT, and MCP1 and TGF-β(1) mRNA expressions all increased significantly (P<0.05). High and very high doses of losartan, compared with the routine dose, obviously reversed these changes.

CONCLUSIONHigh-dose losartan can effectively control blood pressure, reduce renal damage and fibrosis, and inhibit MCP1 and TGF-β(1) expression in rats with UUO, and at a very high dose, losartan can more effectively reduce 24-h Upro than the high-dose group. High and very high doses of losartan offer better protective effect on the kidney in rats with UUO.

Animals ; Chemokine CCL2 ; metabolism ; Fibrosis ; etiology ; prevention & control ; Kidney ; metabolism ; pathology ; Losartan ; pharmacology ; Male ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; metabolism ; Ureteral Obstruction ; complications ; drug therapy