Objective:To observe the clinical effect of elemene injection in the perioperative treatment of esophageal cancer.Methods:A total of 180 patients with esophageal cancer who underwent surgical treatment in the Affiliated Hospital of Hebei University from January 2017 to July 2018 were selected and divided into the experimental group ( n=90) and the control group ( n=90) according to the random sequence number generated by the computer. In the experimental group, the thoracic cavity was rinsed and the elemene was instilled and intravenously instilled. The control group was treated with normal saline. Safety indexes, short-term efficacy indexes, immune indexes, tumor marker levels and long-term benefit indexes were observed in the two groups. Results:The incidences of leukocytosis, thrombocytopenia, low hemoglobin, elevated creatinine, transaminase elevation, nausea and vomiting in the experimental group were 43.33% (39/90), 0 (0/90), 5.55% (5/90), 6.67% (6/90), 4.44% (4/90) and 0 (0/90), those in the control group were 53.33% (48/90), 1.11% (1/90), 2.22% (2/90), 4.44% (4/90), 7.78% (7/90) and 1.11% (1/90), and there were no significant differences between the two groups ( χ2=1.802, P=0.179; P=1.000; χ2=0.595, P=0.441; χ2=0.424, P=0.515; χ2=0.871, P=0.351; P=1.000). The postoperative extubation time in the experimental group was (173.36±41.09) h, the postoperative hospital stay was (14.82±4.35) d, the Karnofsky functional status (KPS) score was 81.43±3.89, and those in the control group was (175.76±40.46) h, (15.34±5.22) d and 80.49±2.67, respectively. The differences between the two groups were not statistically significant ( t=-0.395, P=0.695; t=-0.726, P=0.472; t=1.890, P=0.061). The total amount of drainage fluid in the experimental group was (665.39±201.31) ml, and the incidence of anastomotic fistula was 1.11% (1/90), which were significantly lower than those in the control group [(732.67±213.84) ml and 8.89% (8/90)], with statistically significant differences ( t=-2.173, P=0.032; χ2=4.211, P=0.040). Before treatment, there were no statistically significant differences in immune function between the two groups (all P>0.05). One week after surgery, there was no statistically significant difference in CD3 + between the two groups [(55.45±6.96)% vs. (53.71±6.54)%, t=1.728, P=0.087]; CD4 + , CD4 + /CD8 + and NK cells in the experimental group were higher than those in the control group, and the differences were statistically significant [(29.43±5.05)% vs. (25.92±8.06)%, t=3.501, P=0.001; 1.30±0.21 vs. 1.23±0.20, t=0.229, P=0.028; (254.20±15.21)/μl vs. (237.05±10.73)/μl, t=2.741, P=0.007]. The levels of tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) in the experimental group were (1.37±0.18) ng/ml, (1.26±0.28) ng/ml, (0.89±0.17) ng/ml and (1.06±0.24) ng/ml, significantly lower than those in the control group [(2.86±0.42) ng/ml, (2.92±0.45) ng/ml, (2.38±1.55) ng/ml, (2.82±0.15) ng/ml], and the differences were statistically significant ( t=13.928, P=0.014; t=19.728, P=0.011; t=17.924, P=0.006; t=16.625, P=0.003). The 1-year recurrence rate was 2.22% (2/90) in the experimental group, and the half-year mortality rate was 1.11% (1/90) in the experimental group, and 5.56% (5/90) and 2.22% (2/90) in the control group, with no statistically significant differences ( χ2=0.595, P=0.441; χ2=0.000, P=1.000). Conclusion:Elemene tumor-free sequential treatment combined with postoperative intravenous drip has a positive effect on postoperative recovery of patients with esophageal cancer, which can prevent the occurrence of postoperative anastomotic fistula, improve patients′ immune function, reduce the levels of tumor markers, and it is safe and feasible.

Objective:To explore whether transjugular intrahepatic portosystemic shunt (TIPS) can improve the prognosis of esophagogastric variceal bleeding (EGVB) combined with sarcopenia in cirrhotic patients.Methods:A retrospective cohort study was performed. A total of 464 cases with cirrhotic EGVB who received standard or TIPS treatment between January 2017 and December 2019 were selected. Regular follow-up was performed for the long-term after treatment. The primary outcome was transplantation-free survival. The secondary endpoints were rebleeding and overt hepatic encephalopathy (OHE). The obtained data were statistically analyzed. The t-test and Wilcoxon rank-sum test were used to compare continuous variables between groups. The χ2 test, or Fisher's exact probability test, was used to compare categorical variables between groups. Results:The age of the included patients was 55.27±13.86 years, and 286 cases were male. There were 203 cases of combined sarcopenia and 261 cases of non-combined sarcopenia. The median follow-up period was 43 months. The two groups had no statistically significant difference in follow-up time. There was no statistically significant difference in transplant-free survival between the TIPS group and the standard treatment group in the overall cohort ( HR=1.31, 95% CI: 0.97-1.78, P=0.08). The TIPS patient group with cirrhosis combined with sarcopenia had longer transplant-free survival (median survival: 47.76 vs. 52.45, χ2=4.09; HR=1.55, 95 CI: 1.01~2.38, P=0.04). There was no statistically significant difference in transplant-free survival between the two kinds of treatments for patients without sarcopenia ( HR=1.22, 95% CI: 0.78~1.88, P=0.39). Rebleeding time was prolonged in TIPS patients with or without sarcopenia combination (patients without combined sarcopenia: median rebleeding time: 39.48 vs. 53.61, χ2=18.68; R=2.47, 95 CI: 1.67~3.65, P<0.01; patients with sarcopenia: median rebleeding time: 39.91 vs. 50.68, χ2=12.36; HR=2.20, 95 CI: 1.42~3.40, P<0.01). TIPS patients had an increased 1-year OHE incidence rate compared to the standard treatment group (sarcopenia patients: 6.93% vs. 16.67%, χ2=3.87, P=0.049; patients without sarcopenia combination: 2.19% vs. 9.68%, χ2=8.85, P=0.01). There was no statistically significant difference in the long-term OHE incidence rate between the two kinds of treatment groups ( P>0.05). Conclusion:TIPS can significantly prolong transplant-free survival compared to standard treatment as a secondary prevention of EGVB concomitant with sarcopenia in patients with cirrhosis. However, its advantage is not prominent for patients with cirrhosis in EGVB without sarcopenia.

Objective To investigate the accuracy of liver stiffness (LS) as a noninvasive index in predicting hepatic venous pressure gradient (HVPG) in patients with decompensated liver cirrhosis and the value of LS in the diagnosis of decompensated liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 88 patients with decompensated cirrhosis due to viral hepatitis or decompensated alcoholic cirrhosis who received both HVPG measurement and LS measurement by acoustic radiation force impulse (ARFI) in Department of Gastroenterology, Nanjing Drum Tower Hospital, from April 2013 to June 2021, and according to HVPG, the patients were divided into serious portal hypertension (SPH) (HVPG≥20 mmHg) group with 24 patients and non-SPH (HVPG < 20 mmHg) group with 64 patients. The two groups were compared in terms of LS, spleen stiffness, portal vein velocity, and related biochemical parameters. The t -test or the Mann-Whitney U rank sum test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. A Pearson correlation analysis was used to investigate the correlation of different noninvasive indices with HVPG, and a Logistic regression analysis was used to investigate the association of different noninvasive indices with the risk of SPH. Receiver operating characteristic (ROC) curves were plotted for different noninvasive indices in predicting HVPG≥20 mmHg, and the area under the ROC curve (AUC), sensitivity, specificity, maximum Youden index, and corresponding cut-off value were calculated to investigate the value of each index in predicting SPH. Results Among the 88 patients, 76 had decompensated cirrhosis due to viral hepatitis and 12 had decompensated alcoholic cirrhosis. There were no significant differences between the SPH group and the non-SPH group in age, sex, white blood cell count, hemoglobin, platelet count, prothrombin time, alanine aminotransferase, aspartate aminotransferase, albumin, serum sodium, creatinine, Child-Pugh class, and spleen stiffness, while there was a significant difference in LS between the two groups ( t =-3.970, P < 0.01). The correlation analysis showed that HVPG was positively correlated with LS ( r =0.458, P < 0.001). The Logistic regression analysis showed that LS was a risk factor for SPH (odds ratio=3.941, 95% confidence interval: 1.245-12.476, P =0.020). The ROC curve analysis showed that LS had an AUC of 0.751 in predicting the onset of SPH, with a sensitivity of 54.17% and a specificity of 90.63% at the optimal cut-off value of 2.295 m/s. Conclusion In patients with decompensated cirrhosis, LS measured by ARFI is correlated with HVPG and has a certain value in the non-invasive diagnosis of decompensated cirrhosis with HVPG≥20 mmHg.