Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.

Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.

Objective: To investigate the effects of beta-blocker, propranolol and timolol on the proliferation and apoptosis of hemangioma stem cells (HemSCs). Methods: Different concentrations(3, 30, 90, 150 μmol/L)of propranolol and timolol were added in HemSCs culture respectively for 24, 48 and 72 h, and cell proliferation and apoptosis were detected by flow cytometry. Experimental data were analyzed using SPSS 19.0 software. Statistically significance was determined using Student′s t test. Values of P<0.05 were considered statistically significant. Results: Proliferation assay indicated that different concentrations of propranolol and timolol could inhibit HemSCs proliferation, and inhibition degree increased with increasing concentration. However, the effects of propranolol was slightly stronger than that of timolol at high concentrations (30, 90 and 150 μmol/L), but the opposite was observed at low concentration(3 μmol/L)(P<0.05). The results of apoptosis experiment showed that timolol had stronger effect than propranolol in promoting apoptosis at low concentrations (3 and 30 μmol/L), which was 13.7% and 1.1% higher, respectively. Conclusions Inhibiting HemSCs proliferation and promoting apoptosis may be one of the mechanisms of propranolol and timolol in treating infantile hemangioma.The specific effects of both varies with the concentration and time.

Objective To establish a reliable method of isolation and culture of infantile hemangioma stem cells (HemSCs).Methods Proliferating infantile hemangioma specimens were digested with collagenase to form a single cell suspension.The HemSCs were isolated with anti-CD133 MicroBeads,and were incubated in fibronectin coated 96-well plates with EBM-2 (10％ FBS).HemSCs were identified by morphological characteristics,flow cytometry,cell tubule formation assay,osteoinductive and adipogenic differentiation assay,and subcutaneous tumor formation assay.Results This method enables the rapid isolation of HemSCs which demonstrated typical mesenchymal stem cell morphology in culture.CD133 (+)HemSCs expressed CD29 (99.5％),CD44 (97.9％),CD90 (87.6％) and CD105 (98.5％),but barely expressed CD31 (0.2％),CD34 (0.1％),CD45 (0.1％) and CD144 (0.1％).These cells could differentiate into osteoblasts and adipocytes,and could form vascular wall like structure in vitro.When implanted into subcutaneous of the nude mice,the cells can develop into hemangioma like lesion histologically.Conclusions This technique can effectively isolate HemSCs from the proliferative hemangioma.These cells could be further used to reveal the charaeteristics of HemSCs,as well as for further study of widespread application.

Objective To establish a reliable method of isolation and culture of infantile hemangioma stem cells (HemSCs).Methods Proliferating infantile hemangioma specimens were digested with collagenase to form a single cell suspension.The HemSCs were isolated with anti-CD133 MicroBeads,and were incubated in fibronectin coated 96-well plates with EBM-2 (10％ FBS).HemSCs were identified by morphological characteristics,flow cytometry,cell tubule formation assay,osteoinductive and adipogenic differentiation assay,and subcutaneous tumor formation assay.Results This method enables the rapid isolation of HemSCs which demonstrated typical mesenchymal stem cell morphology in culture.CD133 (+)HemSCs expressed CD29 (99.5％),CD44 (97.9％),CD90 (87.6％) and CD105 (98.5％),but barely expressed CD31 (0.2％),CD34 (0.1％),CD45 (0.1％) and CD144 (0.1％).These cells could differentiate into osteoblasts and adipocytes,and could form vascular wall like structure in vitro.When implanted into subcutaneous of the nude mice,the cells can develop into hemangioma like lesion histologically.Conclusions This technique can effectively isolate HemSCs from the proliferative hemangioma.These cells could be further used to reveal the charaeteristics of HemSCs,as well as for further study of widespread application.