OBJECTIVETo investigate the therapeutic efficacy of endoscopic variceal ligation (EVL) for treating various types of gastric varices (GV) by reviewing patient cases in order to identify the influencing factors of EVL-related recurrence and rebleeding.

METHODSThe medical records of 101 GV cases treated by EVL in our department between January 2008 and October 2012 were retrospectively reviewed. The cases were grouped according to GV type: type 1 (GOV1, n = 63), type 2 (GOV2, n = 18), GOV1 coexisting with GOV2 (n = 11), isolated GOV1 (IGV1, n = 9), and GOV2 (IGV2, n = 0). Data from follow-up examinations (range: 1.5 - 48.0 months, average: 14.9 +/- 9.1 months) were extracted for analysis and included early (less than 72 h after EVL) and late (72 h to 6 weeks after EVL) rebleeding and recurrence. In addition, data from computed tomography (CT) or CT angiography (CTA), performed in 32 of the patients, were extracted to determine the influence of supplying veins, gastrorenal or splenorenal shunts, and portal vein and/or splenic vein diameters on GV recurrence. Data analysis was carried out by ANOVA, Chi-square, Fisher's exact or rank-sum tests, as appropriate. Kaplan-Meier analysis was used to evaluate the time of first recurrent bleeding, and the log-rank test was used to compare between-group differences.

RESULTSGOV2 and IGV1 varices were more severe than the varices of GOV1 (GOV2 and GOV1: u = -2.960; IGV1 and GOV1: u = -2.871; both P less than 0.05). GOV1 had a significantly lower recurrence rate than all other GV types (x2 = 7.054, P less than 0.05). The CT and CTA data indicated that all GV were supplied by left gastric veins, while 83.3% of IGV1 had blood supplementation by left gastric veins and short gastric or posterior gastric veins, and 100% of IGV1 had gastrorenal or splenorenal shunts. Approximately one-half of the total GV cases (56.3%, 18/32) had gastrorenal or splenorenal shunts, and this parameter was correlated with portal vein diameter (t = -2.766, P less than 0.05). The presence of gastrorenal or splenorenal shunts was correlated with both recurrence and rebleeding (P less than 0.05).

CONCLUSIONEVL can effectively control bleeding and prevent rebleeding for GV; although, the best therapeutic efficacy and lowest rate of recurrence was achieved in GOV1 cases. The presence of gastrorenal or splenorenal shunts increases the risk of GV recurrence.

Adult ; Aged ; Endoscopy, Digestive System ; Esophageal and Gastric Varices ; surgery ; Female ; Humans ; Ligation ; methods ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the effect of a phospholipid-coated microbubble contrast agent for myocardium opacification in comparison with a albumin-coated microbubble contrast agent (Quanfuxian).

METHODSIn 10 dogs with single coronary artery stenosis involving the anterior descending branch or circumflex branch randomly received infusion of the two contrast agents through the femoral vein. The myocardial blood flow, heart rate and blood pressure were analyzed qualitatively and quantitatively. The concentration and the particle diameter of the two contrast agents were determined.

RESULTSThe concentration of the phospholipid-coated microbubbles was (1.06-/+0.22) x10(9)/ml, with a diameter of 3.04-/+0.34 microm, similar to the concentration and diameter of Quanfuxian ((1.31-/+0.33)x10(9)/ml and 2.88-/+0.58 microm, respectively, P>0.05). Both of the agents achieved grade three myocardium opacification, and produced no obvious effect on the heart rate and blood pressure. Quantitative analysis of myocardial opacification in terms of myocardial blood volume (A), blood velocity (beta), and blood flow (A x beta) revealed no significant difference between the two agents (P>0.05), and the parameters derived from the two agents showed good correlations (P<0.05, rA=0.809, r beta=0.932, rA.beta=0.925).

CONCLUSIONThe phospholipid-coated microbubble contrast agent shows good effect for myocardial opacification without significant difference from Quanfuxian. Both of the agents are good ultrasound contrast agents for quantitative analysis of myocardium blood flow.

Albumins ; chemistry ; Animals ; Contrast Media ; administration & dosage ; chemistry ; Coronary Stenosis ; diagnostic imaging ; Dogs ; Echocardiography ; methods ; Female ; Male ; Microbubbles ; Phospholipids ; chemistry

Background: Metastatic colorectal cancer (mCRC) patients with progressive disease after all available standard therapies need new medication for further treatment. Famitinib is a small-molecule multikinase inhibitor, with promis-ing anticancer activities. This multicenter, randomized, double-blinded, placebo-controlled, phase II clinical trial was designed to evaluate the safety and efficacy of famitinib in mCRC. Methods: Famitinib or placebo was administered orally once daily. The primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), quality-of-life (QoL), and safety. Results: Between July 18, 2012 and Jan 22, 2014, a total of 167 patients were screened, and 154 patients were rand-omized in a 2:1 ratio to receive either famitinib (n = 99) or placebo (n = 55). The median PFS was 2.8 and 1.5 months in the famitinib and placebo groups (hazard ratio = 0.60, 95% confidence interval = 0.41–0.86, P = 0.004). The DCR was 59.8% and 31.4% (P = 0.002) and the ORR was 2.2% and 0.0% (P = 0.540) in the famitinib and placebo groups, respectively. The most frequent grade 3–4 adverse events were hypertension (11.1%), hand-foot syndrome (10.1%), thrombocytopenia (10.1%), and neutropenia (9.1%). Serious adverse events occurred in 11 (11.1%) patients in the famitinib group and 5 (9.1%) in the placebo group (P = 0.788). The median OS of the famitinib and placebo groups was 7.4 and 7.2 months (P = 0.657). Conclusion: Famitinib prolonged PFS in refractory mCRC patients with acceptable tolerability. Trial registration This study was registered on ClinicalTrials.gov (NCT01762293) and was orally presented in the 2015 ASCO-Gastrointestinal Symposium