Objective To observe the efficacy of transjugular interventional therapy for patients with hepatic myelopathy after transjugular intrahepatic portosystemic shunt (TIPS).Methods Sixteen patients with hepatic myelopathy afte TIPS were treated with interventional therapy again.Four patients who were treated with drugs through shunt previously had poor prognosis,then the remaining 12 patients treated with current limited shunt had better prognosis,which were analyzed in this study.Activities of daily living were assessed by Barthel index,limb muscle strength scores were assessed by Lovette scoring system.The changes of liver function and portal vein pressure were analyzed by paired t-test,while other data such as serum ammonia level,Barthel index,Lovette scores before and after transjugular interventional therapy were compared by analysis of variance with repeated measurements.Results All the patients had no complication after operations.The liver function and portal vein pressure of 12 patients had no significan change before and after operation.Blood ammonia value were (77.9 ± 17.9) mmol/L after TIPS,(77.9 ± 14.8),(73.4 ± 21.5),(59.5 ± 14.5),(52.0 ± 16.5) mmol/L 1,3,6,12 months after current limited shunt.Compared with that of preoperation(F =6.45,P ＜0.05),it decreased significantly at the 6th and 12th month.Limb muscle strength scores were 2.1 ± 0.7 before current limited shunt,2.3 ± 0.8,3.1 ± 1.0,3.2 ± 1.1,2.8 ± 0.9 1,3,6,12 months after the operation.Compared with preoperation (F =4.97,P ＜ 0.05),muscle strength grading improved significantly at the 3rd,6th and 12th month.Activities of daily living Barthel index were 42.1 ± 10.5 before current limited shunt,47.1 ± 11.0,45.0 ± 8.8 3,6 months after the operation.Compared with preoperation (F =5.05,P ＜ 0.05),activities of daily living had improvement.There were 3,6,2,1 cases of hepatic encephalopathy of Ⅰ,Ⅱ,Ⅲ,Ⅳ stage after TIPS.Three months after current limited shunt there were 7,3,1,0 cases,while there were 8,1,1,0 cases 6 months after the operation.In other 4 patients treated with drugs,2 patients died of liver failure,one was lost to follow.Conclusions Interventional therapy can relieve symptoms of hepatic myelopathy.The operation is safe,effective,and helpful after TIPS treatment.

Objective:To study the expression of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2) in hilar cholangiocarcinoma.To discuss the relationship of MMP-2 and TIMP-2 expression with the metastasis and prognosis of hilar cholangiocarcinoma.Methods:Immunohistochemical S-P method was used in the examination of MMP-2 and TIMP-2 expression in 78 hilar cholangiocarcinoma.The relationships of MMP-2 and TIMP-2 expression with the pathological differentiation,metastasis and prognosis were analyzed.Results:The positive rate of MMP-2 expression was 72% ,and that of TIMP-2 was 76%.According to Ridit analysis,the degree of MMP-2 expression were correlated with the pathologic differentiation and lymph-node metastasis of hilar cholangiocarcinoma.The high expression of MMP-2 existed in the low pathologic differentiation and the high rate of lymph-node metastasis of hilar cholangiocarcinoma.The high expression of TIMP-2 existed in the high pathologic differentiation and the low rate of lymph node metastasis of hilar cholangiocarcinoma. MMP-2 and TIMP-2 expression had a significance correlation(r=0.708,P

Medical microbiology is an important basic subject in medical colleges.In view of the multifarious and abstract nature of the specialized course and the dull atmosphere in classroom teaching,we have adopted a doggerel teaching method in order to enliven the classroom atmosphere and improve the class teaching quality.After long-term teaching practice,it's been proved that the proper use of doggerel in classroom teaching can not only refresh boring theory and enhance students' learning interesting,but also simplify the complicated context and improve their memorizing ability and learning efficiency,posing a significant impact on the teaching effects of medical microbiology.

Objective To establish an anatomical classification of chronic portal vein thrombosis (PVT) in order to guide the transjugular intrahepatic portasystemic shunt (TIPS) manipulation, and to analyze the correlation between anatomical classification of PVT and the occurrence of hepatic encephalopathy (HE) after TIPS. Methods During the period from June 2010 to June 2013 at authors’ hospital, TIPS with fluency covered stent was carried out in a total of 73 patients with chronic portal vein thrombosis. Based on the location of portal vein thrombosis, the anatomical classification of portal vein thrombosis (PVT-type) was initially established. The changes in portal vein pressure after TIPS were evaluated. The occurrence of HE at 15 days and at 3 and 6 months after TIPS in patients with different PVT-type was statistically analyzed. As the understanding of 0-phase minimal hepatic encephalopathy (MHE) was deepened, the authors added a subdivision to the 0-phase, including normal cognitive function state and minimal hepatic encephalopathy (MHE) into West - Haven grading to further precisely assess the hepatic encephalopathy. Using paired samples t-test, the changes of portal vein pressure after TIPS were evaluated. The grading of hepatic encephalopathy and the number of occurrence after TIPS were particularly recorded, the results were compared between groups at the same time and between the types at different times. Results The preoperative and postoperative portal vein pressure in type Ⅰ patients receiving TIPS therapy was (42.7 ± 9.6) and (35.0 ± 6.7) cm H2O respectively, the difference was statistically significant (t = 7.61, P <0.01);in typeⅡpatients it was(39.8 ± 5.5) and(31.0 ± 5.7) cm H2O respectively(t=17.2, P<0.01);in type Ⅲpatients it was (43.2 ± 5.8) and (32.4 ± 5.0) cm H2O respectively (t = 25.0, P < 0.01); and in type Ⅳpatients it was (43.0 ± 3.7) and (36.6 ± 6.6) cm H2O respectively (t = 4.26, P <0.01). The occurrence of HE 15 days after TIPS was mainly seen in patients with type Ⅳ , Ⅰ and Ⅲb. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with PVT-type Ⅱa, Ⅲb and type Ⅰ. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with PVT-type Ⅱb, Ⅲb and type Ⅰ. Three months after TIPS, the occurrence of MHE was mainly seen in patients of Ⅲa, Ⅱa and Ⅱc type. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with Ⅲa, Ⅱb and Ⅳ type. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with PVT-typeⅡa,Ⅱb andⅢb. Six months after TIPS, the occurrence of MHE was mainly seen in patients of type Ⅱa, Ⅱc and Ⅲb. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with type Ⅱb, Ⅰ and Ⅲb. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with typeⅡb,Ⅲb andⅠ. The HE condition lasted for longer time in patients withⅡb,Ⅲb andⅠtype. Conclusion The establishment of a rational anatomical classification for chronic portal vein thrombosis can effectively guide the clinical application of TIPS. The occurrence of postoperative hepatic encephalopathy is higher in patients with pure main portal vein thrombosis or superior mesenteric vein thrombosis.

ObjectiveTo define the maximum tolerated dose (MTD) of weekly cisplatin in concurrent chemoradiotherapy for Chinese cervical carcinoma.MethodsCervical carcinoma of stage ⅠB2- ⅣA were eligible for the study.PhaseⅠstudy was dose-escalation trial with 15 patients.All patients received whole pelvic radiotherapy with three dimentional conformal radiotherapy technique. Concurrent cisplatin started from the dose of 20 mg/m2 to 25 mg/m2,30 mg/m2,35 mg/m2,40 mg/m2 for the weekly schedule ( ≥3 patients per dose group) and the doses were steadily escalated to 40 mg/.m2.If the dose was increased to 40 mg/m2 without dose-limiting toxicity ( DLT),40 mg/m2 would be the maximum tolerated dose (MTD).According to the MTD dose from Phase Ⅰ study,we conducted phase Ⅱ clinical trial with 36 patients.ResultsIn Phase Ⅰ study,cisplatin dose was escalated to 40 mg/m2 and DLT had not been reached.Thirty-six patients in Phase Ⅱ study included 9 inpatients and 27 outpatients.All 9 inpatients completed 6 cycles of chemotherapy. In 27 outpatients,18 patients (66％) completed 6 cycles of chemotherapy,19 patients (70％) completed 5 cycles and 25 patients (92％) completed 4 cycles of chemotherapy.All patients completed radiotherapy.Major adverse effects were grade 1 and 2 gastrointestinal toxicities and neutropenia.ConclusionsWeekly 40 mg/m2 cisplatin concurrent with radiotherapy is well tolerated when given to Chinese patients with cervical carcinoma. For outpatients with poor performance status,the cisplatin dose needs to be reduced.

Objective To evaluate the safety,effectiveness and clinical factors of re-intervention of transjugular intrahepatic porto-systemic shunt (TIPS).Methods A retrospective study of safety and longterm outcomes of TIPS was made in 771 patients from August 1994 to August 2010.The 625 patients had follow-up data.The patients who received TIPS once,twice,and more than twice were divided into group 1,group 2 and group 3,respectively.Clinical symptoms,survival rate and restenosis rate of each group were analyzed.Clinical influencing factors of re-intervention effect were discussed.Results The success rate of first intervention was 98.2％ (757/771),the death rate was 0.7％ (5/757) and severe complication rate was 2.5％ (19/757).The success rate of re-intervention was 98.7％ (457/463),no death and severe complications occurred.The restenosis rate in group 3 decreased significantly than group 1 ( x2 =7.908,P ＜0.05 ) in the first year of TIPS.The restenosis rates in group 2 and group 3 were lower than group 1 from 2 to 5 years of TIPS ( x2 values were 27.046,25.724,37.002 and 19.046,respectively,P ＜ 0.05 ). The survival rate in group 3 was higher than group 1 (x2 =9.114,P＜0.05)and group 2 was higher than group 1 ( x2 =4.929,P ＜ 0.05 ) in the first year of TIPS,while there was no statistical difference between group 2 and group 3 ( x2 =2.678,P ＞ 0.05).The patients in group 2 and group 3 also had higher survival rates than group 1 from 2 to 5 years of TIPS (x2 value were 41.314,26.920,13.692 and 6.713,respectively,P ＜ 0.05 ).19.4％ (79/406)of patients who received re-intervention had symptom recurrence and shunt stenosis or occlusion. 11.6％ (47/406) of patients had symptom recurrence with portal hypertension signs,62.8％ (255/406) had shunt stenosis or occlusion with portal hypertension signs.Conclusions Restenosis or occlusion of TIPS,symptom recurrence and portal hypertension signs were important factors for re-intervention.Re-intervention of TIPS was safe and effective,and could improve the survival rate of patients with TIPS.

Objective:To study the efficacy of direct intrahepatic portosystemic shunt (DIPS) in treatment of Budd-Chiari syndrome (BCS).Methods:From January 1, 2015 to June 31, 2017, consecutive patients with BCS who were treated with DIPS at the Department of Interventional Therapy of Beijing Shijitan Hospital, the Liver Disease Research Center of Beijing Friendship Hospital and the General Surgery Department of Beijing Ditan Hospital were retrospectively analyzed. The symptoms, physical signs (including abdominal distension, ascites, pleural effusion, splenomegaly, hepatic encephalopathy) and perioperative laboratory results of these patients were collected and analyzed. Biochemical indicators including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil), and portal pressure gradient were compared before and 2 weeks after treatment. The patients were followed up for at least 3 years to assess their clinical symptoms, patency of shunt, oncological status and survival.Results:Of 67 patients with BCS who were included in the study, there were 45 males and 22 females, aged (38.12±23.22) years. The BCS classification of these patients were hepatic vein type ( n=65), including 62 patients with complete hepatic vein obstruction, 3 patients with hepatic vein occlusion due to thrombosis, and 2 patients with mixed hepatic vein and inferior vena cava occlusion. All 67 patients underwent DIPS with 93 stents being implanted. In addition, 43 patients underwent gastric coronary vein embolization, and 2 patients with mixed type of BCS underwent inferior vena cava stenting. The portal pressure gradient decreased from (22.17±9.16) mmHg (1 mmHg=0.133 kPa) to (9.87±4.75) mmHg, the difference was statistically significant ( P<0.05). Abdominal distension was relieved, at one month and ascites completely subsided in 3 months after operation. The liver congestion and swelling were obviously relieved. Comparison of patients 2 weeks after operation and before operation, ALT decreased from (65.28±27.75) U/L to (28.43±13.46)U/L, AST from (68.75±29.23) U/L to (26.92±13.33)U/L, TBil from (175.31±80.48)μmol/L to (45.08±26.54)μmol/L, DBil from (127.55±44.65)μmol/L to (35.12±10.77)μmol/L, and albumin increased from (31.56±7.22) g/L to (44.18±11.36)g/L, the difference was statistically significant (all P<0.05). All patients were followed up for at least 3 years. Shunt stenosis was detected in 5 patients (7.46%) with shunt expansion being performed, variceal bleeding in 2 patients (2.99%), ascites recurrence in 4 patients (5.97%) and hepatic encephalopathy in 2 patients (2.99%). No patients were diagnosed with hepatic cancer, and no patients died. Conclusion:DIPS was efficacious, safe and reliable to that BCS patients. It rapidly reduced portal venous pressure, relieved liver congestion, and restored liver morphology and liver function in these patients.

Objective To investigate the association of tumor necrosis factor-ot (TNF-α) gene promoter polymorphisms with generalized pustular psoriasis.Methods Totally,91 patients of Han nationality with generalized pustular psoriasis (generalized pustular psoriasis group) and 102 health checkup examinees (healthy control group) were enrolled into this study.PCR and direct sequencing were performed to analyze the-238,-308 and-857 polymorphic sites of the TNF-α promoter.Results The frequency of the A allele at TNF-α-238 site was significantly higher in the generalized pustular psoriasis group than in the healthy control group (P =0.003,OR =4.819,95％ CI:1.581-14.694),so was the frequency of GA/AA genotype (P =0.006,OR =4.455,95％ CI:1.410-14.077).However,no significant differences were observed in the frequencies of G/A alleles (P =0.794) and GG/GA/AA genotypes (P =0.786) at TNF-o-308 site,or in the frequencies of C/T alleles (P =0.474) and CC/CT/TT genotypes (P =0.453) at TNF-α-857 site,between the generalized pustular psoriasis group and healthy control group.Conclusion TNF-α-238G ＞ A polymorphisms may be associated with the occur-rence of generalized pustular psoriasis.

ObjectiveTo investigate the clinical value of indocyanine green retention rate at 15 minutes (ICG-R15), Child-Turcotte-Pugh (CTP) class, and Model for End-Stage Liver Disease (MELD) score in predicting post-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) in liver cancer patients with portal hypertension. MethodsA retrospective analysis was performed for the clinical data of 95 liver cancer patients with portal hypertension who underwent TIPS in Department of Interventional Therapy in Beijing Shijitan Hospital from January 2015 to June 2017, and according to the presence or absence of HE after TIPS, they were divided into HE group with 24 patients and non-HE group with 71 patients. ICG-R15, CTP class, and MELD score were determined for all patients before surgery. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test and the Fisher’s exact test were used for comparison of categorical data between two groups. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for HE after TIPS, and the receiver operating characteristic (ROC) curve was used to analyze the value of ICG-R15, CTP class, and MELD score in predicting HE. ResultsThe incidence rate of HE was 25.2% (24/95) within 12 months after TIPS. The univariate analysis showed that stent location (P=0.021), ICG-R15 (P=0.005), and CTP class (P=0.040) were associated with HE after TIPS. The multivariate analysis showed that stent located in the right portal vein (OR=3.373, 95% CI: 2.346~5.103, P=0.010) and ICG-R15＞30% (OR=2.107, 95% CI: 1.331~3.212, P=0.036) were independent risk factors for HE after TIPS in liver cancer patients with portal hypertension. The ROC curve analysis showed that ICG-R15, MELD score, and CTP class had an area under the ROC curve of 0.659, 0.638, and 0.621, respectively, in predicting HE after TIPS. ConclusionICG-R15 has a certain clinical value in predicting HE after TIPS in liver cancer patients with portal hypertension.

Objective To investigate the clinical efficacy of transjugular intrahepatie portosystemie shunting (TIPS) for recurrent portal hypertension after liver transplantation.Methods The retrospective crosssectional study was conducted.The clinical data of 15 patients with recurrent portal hypertension after liver transplantation who underwent TIPS in the 9th School of Clinical Medicine between January 2008 to June 2016 were collected.Course of TIPS:the portal vein pressure was measured and varicose veins were embolized after puncture,cannulation and angiography.A balloon catheter with diameter of 7 mm or 8 mm was used to dilate the preshunt channel,and a covered stent or bare stent with a diameter of 7,8 or 10 mm was implanted to establish the shunt channel.Portal vein angiography was performed and the portal vein pressure was measured again.Observation indicators:(1) Surgical situations;(2) changes of portal vein pressure before and after TIPS;(3)follow-up and survival situations.Follow-up using outpatient examination was performed to record clinical symptoms at postoperative 1,3,6 and 12 months.Regular hepatic vascular ultrasonography was done at postoperative 1,3,6 and 12 months to detect patency of shunt.The follow-up period was up to June 2018.Measurement data with normal distribution were represented as (x) ±s and analyzed by the paired t test.Measurement data with skewed distribution were described as M (range).Count data were represented as percentage.Results (1) Surgical situations:all the 15 patients underwent successful TIPS,without any serious complications or death.Stent implantation situation:bare stent,covered stent and bare stent + covered stent were implanted in 4,8 and 3 patients,respectively.Among the 15 patients,7 mm,8 mm and 10 mm diameter shunt channel were established in 4,8 and 3 patients respectively.(2) Changes of portal vein pressure before and after TIPS:portal vein pressure of the 15 patients decreased from (34±8)mmHg (1 mmHg=0.133 kPa) to (21±7)mmHg before and after TIPS,with a statistically significant difference (t =7.07,P＜0.05).Portal vein pressure gradient decreased from (26± 9)mmHg to (12±5)mmHg before and after TIPS,with a statistically significant difference (t=6.43,P＜0.05).(3) Follow-up and survival situations:15 patients were followed up for 24.0-60.0 months,with a median follow-up time of 37.8 months.Main clinical symptoms:of 12 patients with gastrointestinal hemorrhage,3 had gastrointestinal rehemorrhage mainly due to portal vein pressure rising again caused by shunt restenosis or occlusion,9 had no gastrointestinal rehemorrhage.Of 5 patients with portal vein thrombosis,thrombus was disappeared basically in 3 patients and decreased obviously (no effect on blood flow) in 2 patients.Three patients with refractory ascites were effectively improved after TIPS,however,2 of them were recurred at postoperative 5 months.Postoperative restenosis or occlusion of shunt channel:among 15 patients,7 developed restenosis or occlusion of the shunt channel (including 4 with bare stents).Five of them underwent shunt recanalization and another 2 without special clinical symptoms had no treatment.Hepatic encephalopathy:6 of 15 patients including 1 with 7 nun shunt,3 with 8 mm shunt and 2 with 10 mm shunt developed hepatic encephalopathy,of which grade Ⅰ,Ⅱ,Ⅲ,and Ⅳ hepatic encephalopathy wee detected in 2,3,0 and 1 patients,respectively.Survival situations:of the 15 patients,1 died of hepatic failure at postoperative 6 months,3 were performed liver transplantation again at postoperative 3,8 and 14 months,respectively,11 survived more than 2 years with the longest survival time more than 6 years.Conclusion TIPS is safe and effective for recurrent portal hypertension after liver transplantation for patients who have not effective other treatment.