Objective To explore the prognosis of endoscopic tissue adhesives injection in treating liver cirrhosis patients with esophageal gastric varices (GOV),and to evaluate the effects of various factors on bleeding after treatment.Methods A total of 157 liver cirrhosis patients with GOV treated by endoscopic tissue adhesives injection with or without ligation therapy were retrospectively analyzed.The basic information,liver function and blood biochemical values of patients at enrollment were investigated.The analysis of bleeding after treatment was conducted by Kaplan-Meier.The survival curves comparison was conducted by Log-rank test.Logistic regression model was used for multivariate analysis.The prognosis predictors were evaluated by receiver operating characteristics (ROC) curves and the area under the curve (AUC).Results Rebleeding happened in 26 of 157 patients.The median rebleeding time was 3.4 months.The results of univariate analysis indicated that there were statistical differences in FIB4 scores (Z=-1.282,P=0.100) and the inner diameter of the right portal vein (Z=-1.812,P=0.035) between bleeding group and no bleeding group.The results of multivariate analysis showed that the inner diameter of the right portal vein was independent prognostic factor of rebleeding (OR =1.733,95％ CI:1.045 to 2.874,P =0.033).Optimal diagnostic threshold was 8.5 mm (AUC=0.724,95 ％CI:0.537 to 0.910),sensitivity and specificity was 77.8％ and 66.6％ respectively.Conclusions The inner diameter of the right portal vein was one of the important factors that affected the efficacy of tissue adhesives injection in preventing bleeding and the prognosis.FIB4 score had certain reference value in predicting recurrence or bleeding after treatment.

BACKGROUND/AIMS: Gastroesophageal variceal hemorrhage is a common complication of portal hypertension. Endoscopic therapy is currently recommended for preventing gastroesophageal variceal rebleed. However, the rate of variceal rebleed and its associated mortality remain concerning. This study is aimed at differentiating patient response to endoscopic therapy based on endoscopic ultrasound (EUS) findings. METHODS: One-hundred seventy patients previously treated with repeat endoscopic therapy for secondary prophylaxis were enrolled and classified into two groups based on treatment response. Prior to consolidation therapy, all patients received an EUS examination to observe for extraluminal phenomena. All available follow-up endoscopic examination records were retrieved to validate study results. RESULTS: Of the 170 subjects, 106 were poor responders, while 64 were good responders. The presence of para-gastric, gastric perforating, and esophageal perforating veins was associated with poor patient response (p < 0.001). The odds ratio for para-gastric veins was 5.374. Follow-up endoscopic findings for poor responders with incomplete variceal obliteration was closely correlated with the presence of para-gastric veins (p=0.002). CONCLUSIONS: The presence of para-gastric veins is a characteristic of poor response to endoscopic therapy for treating gastroesophageal varices. Early identification of this subgroup necessitates a change in course of treatment to improve overall patient outcome.
Cyanoacrylates ; Endosonography ; Esophageal and Gastric Varices ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal ; Mortality ; Odds Ratio ; Risk Assessment ; Ultrasonography* ; Varicose Veins* ; Veins

OBJECTIVETo develop an UPLC method of determining the characteristic chromatographic profiles of Moutan Cortex for quality control of the medicine.

METHODThe UPLC characteristic chromatographic profiles of fifteen batches of Moutan Cortex were determined on an HSS T3 column (2.1 mm x 100 mm, 1.8 microm) eluted with the mobile phase consisted of water containing 0.05% phosphoric acid and acetonitrile in gradient mode and the detection wavelength was set at 254 nm.

RESULTThe common mode of the UPLC characteristic chromatographic profile was set up under the established condition. There were 20 common peaks in the characteristic chromatographic profile of fifteen samples, ten of which were identified, and the similar degrees of the fifteen batches to the common mode were between 0.973-0.998.

CONCLUSIONThe method was fast and accurate. The characteristic chromatographic profile of Moutan Cortex with high specificity can be used to control the quality of Moutan Cortex.

Chromatography, Liquid ; methods ; Drugs, Chinese Herbal ; chemistry ; Paeonia ; chemistry ; Quality Control

Objective: To compare the biomechanical performance between the single- versus double-threaded cannulated screws in the treatment of femoral neck fractures of Pauwels type Ⅲ. Methods: Models of femoral neck fracture of Pauwels type Ⅲ (70°) were made of the Sawbone synthetic composite femurs. All specimens were divided into 2 groups (n=12). Group A was fixated with single-threaded cannulated screws and group B with double-threaded cannulated screws, both in an inverted triangle configuration. The screws ranged from 90 to 95 mm in length and from 7.3 to 7.5 mm in diameter. All the specimens were subjected to axial stiffness and failure load tests with 7° valgus (simulating normal two-legged weight-bearing stance) and 25° valgus (simulating normal one-legged weight-bearing stance) and torsion test as well. The 2 groups were compared in the torques at axial stiffness angles of 1°, 2°, 3°, 5° and 7°. Results: Group B had significantly greater axial stiffness at 7° valgus and 25° valgus (89±26 N/mm and 128±37 N/mm) and failure load (1,154±368 N) than group A did (36±12 N/mm and 47±16 N/mm; 688±94 N) (P< 0.05). The torques increased with the increase in rotation angle in both groups. However, the torques in group B (3.26±0.96, 4.16±1.23, 4.64±1.13, 5.59±1.26 and 6.53±1.47 N·m) were all significantly larger than in group A (1.44±0.19, 2.03±0.41, 2.33±0.62, 2.74±0.87 and 3.05±1.07 N·m) (P<0.05). Conclusion Double-threaded cannulated screws may provide better biomechanical stability than single-threaded ones, due to their substantial improvement in anti-compression and anti-rotation performance.

OBJECTIVE To study the metabolites of four diterpenoids of Euphorbia fischeriana in liver microsomes of rats and to investigate its metabolic regularity. METHODS In vitro incubation system of liver microsomes of rats was built. The jolkinolide A，jolkinolide B ，17-hydroxyl jolkinolide A and 17-hydroxyl jolkinolide B were added into incubation system of liver microsomes in rats activated by reduced nicotinamide adenine dinucleotide phosphate ，incubated at 37 ℃ for 30 min，and then terminated the reaction with acetonitrile. Taking the negative group （adding acetonitrile firstly and then starting incubation for 30 min）as the reference，the ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry was used ；Anaylyst®TF 1.7.1、PeakView® 2.2，MetabolitePilot 1.5 and MasterView 1.2 software were used to speculate and identify the fragmentation law of mass spectrometry and metabolites. RESULTS Four diterpenoids were easy to lose neutral fragments such as H 2O and CO in secondary mass spectrometry. Jolkinolide A and 17-hydroxyl jolkinolide A showed similar metabolism pathway ，including dihydroxylation，dehydrogenation，and monohydroxylation ；six and five metabolites were identified respectively. Jolkinolide B and 17-hydroxyl jolkinolide B showed similar metabolism pathway ，including monohydroxylation ，hydration and isomerization. Five metabolites were identified. CONCLUSIONS Both jolkinolide A and 17-hydroxyl jolkinolide A produce the metabolites of hydroxylation and dehydrogenation in liver microsomes of rats ；both jolkinolide B and 17-hydroxyl jolkinolide B produce the metabolites of hydroxylation ，hydration and isomerization in liver microsomes of rats. The metabolites of four diterpenoids are phase Ⅰ metabolites.

OBJECTIVE： To analyze the metabolites of jolkinolide B in rats， and predict its metabolism pathway. METHODS： The rats were randomly divided into blank group （0.5％ CMC-Na， ig） and administration group （jolkinolide B， ig， 100 mg/kg）， with 8 rats in each group. The fecal samples were collected at ＞0-12， ＞12-24， ＞24-36 hours after administration； the urine samples were collected at ＞0-2， ＞2-8， ＞8-12， ＞12-24， ＞24-36， ＞36-48 hours after administration； the blood samples were collected at 1， 2， 8， 12， 24， 36 hours after administration. UPLC-Q-TOF/MS combined with Analyst® TF 1.7.1 and PeakView® 2.2 software were used to analyze and identify the metabolites in the samples after treated with ultrasonic extraction， solid phase extraction and protein precipitation. RESULTS & CONCLUSIONS： Prototype drugs and seven metabolites were detected in rat’s fecal samples， and one or two metabolites were detected in urine and blood samples， respectively. After intragastric administration， the metabolism of jolkinolide B in rats is mainly through ring opening， oxidation， dehydration， deoxygenation and hydrogenation of phase Ⅰ， but no phase Ⅱ metabolites were detected.

OBJECTIVE： To compare low-polarity volatile constituents in supercritical CO2 extract from the roots and stem of Ilex asprella and its effects on the proliferation of IEC-6 in vitro， and to provide reference for making full use of wild resources of I. asprella and expanding its medicinal parts. METHODS： The low-polarity volatile constituents were extracted from the root and stem of I. asprella with supercritical fluid CO2 extraction（SFE-CO2）. The chemical constituents were analyzed by GC-MS. IEC-6 cells were treated with different concentrations of supercritical CO2 extracts （0， 1， 5， 10， 20， 40， 60， 80， 100 μg/mL） from roots or stems of I. asprella. MTT assay was used to detect the relative viability， and cell proliferation curve was drawn and EC50 of each extract were calculated. RESULTS： Sixty-two and forty-six low-polarity volatile constituents were identified from supercritical CO2 extract in the roots and stem of I. asprella with GC-MS； there were 24 common constituents totally， mainly including pelargonic acid（14.18％ and 6.14％），octanoic acid（10.59％ and 4.35％），hexanoic acid（8.63％ and 10.86％），paeonol（7.79％ and 6.00％），2-methyl-3-phenyl-propanal（6.3％ and 0.58％），acetic acid（1.72％ and 33.77％） in root and stem， respectively. The results of cell culture in vitro showed that when the concentration of supercritical CO2 extract from the roots and stems of I. asprella was lower （≤60 μg/mL）， it could significantly promote the proliferation of IEC-6 cells and their EC50 were 16.35， 20.20 μg/mL， respectively； when the concentration of the extract was higher （≥80 μg/mL）， it showed cytotoxicity and inhibited the proliferation of IEC-6 cells. CONCLUSIONS： There are similar species of volatile constituents in roots and stems of I. asprella and similar in vitro bioactivity of the supercritical CO2 extracts to IEC-6 cells. The short-chain fatty acids may be the active ingredient to promote cell proliferation， while paeonol may be the cytotoxic active ingredient.