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Objective To evaluate the clinical efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic cyanoacrylate injection in the treatment of gastric variceal bleeding through a meta-analysis. Methods PubMed, Embase, the Cochrane Library, ScienceDirect, CNKI, and Wanfang Data were searched for the randomized controlled trials (RCTs) of the efficacy of TIPS versus endoscopic cyanoacrylate injection in the treatment of gastric variceal bleeding published up to June 30, 2018. We assessed study quality and extracted data from the included studies. RevMan 5.3 software was used to statistically analyze the data. Results Six RCTs were included, involving 366 cases in the TIPS group and 255 cases in the cyanoacrylate group. The meta-analysis showed no significant difference in the early rebleeding rate between the TIPS group and the cyanoacrylate group (odds ratio ［OR］=1.05, 95% confidence interval ［CI］: 0.53-2.06, P=0.89), but the postoperative late rebleeding rate of the TIPS group was significantly lower than that of the cyanoacrylate group (OR=0.33, 95%CI: 0.19-0.57, P＜0.000 1). There was no significant difference in the mortality between the TIPS group and the cyanoacrylate group (OR=1, 95%CI: 0.65-1.55, P＞0.05). The TIPS group had a significantly increased incidence of postoperative hepatic encephalopathy compared with the cyanoacrylate group (OR=4.09, 95%CI: 1.59-10.58, P=0.004). Conclusions In the long term, the rebleeding rate of gastric variceal bleeding is significantly lower in patients treated with TIPS than in those treated with endoscopic cyanoacrylate injection, so TIPS is an effective method to treat gastric variceal bleeding. [ABSTRACT FROM AUTHOR]

The incidence of non-alcoholic fatty liver disease (NAFLD) has been increasing year by year in China. Intestinal mucosa is the largest organ for bacterial storage, and intestinal mucosal barrier includes biological barrier, mechanical barrier, immunological barrier, and chemical barrier. This article investigates the important role of intestinal mucosal barrier function in the pathogenesis of NAFLD. As for the intestinal biological barrier, abnormalities in gut microbiota occur earlier than obesity and other metabolic disorders; small intestinal bacterial overgrowth may affect energy metabolism, promote insulin resistance, and get involved in the pathogenesis of NAFLD; regulation of gut microbiota has a certain clinical effect in the treatment of NAFLD. Intestinal mechanical barrier impairment increases the mucosal permeability and is associated with intestinal dysbacteriosis. The changes in intestinal immunological barrier may be associated with obesity, metabolic disorders, and liver inflammation. The changes in intestinal chemical barrier can inhibit the synthesis and secretion of very low-density lipoprotein and low-density lipoprotein in hepatocytes and may result in triglyceride deposition in the liver. It is pointed out that the research on intestinal mucosal barrier function provides promising prospects for the prevention and treatment of NAFLD. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Hepatology / Linchuang Gandanbing Zazhi is the property of Journal of Clinical Hepatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the value of contrast - enhanced ultrasound (CEUS) in the differential diagnosis of single metastatic hepatic carcinoma (MHC) and solitary necrotic nodule of the liver (SNNL). Methods A retrospective analysis was performed for 12 patients with single MHC and 16 patients with SNNL who showed circular enhancement in arterial phase on CEUS. Age, size of lesion, and findings of two - dimensional gray - scale ultrasound and CEUS were compared between the two groups. The two - independent - samples t -test was used for comparison between groups, and the paired t - test was used for comparison within each group. Results The MHC group had a significantly higher mean age than the SNNL group (60. 2 ±11.3 years vs 41. 0 ±9.1 years, t - 4. 970, P <0. 001) . The mean diameter of lesion was 2. 86 ± 1. 22 cm in the MHC group and 2. 97 ± 0. 96 cm in the SNNL group , and showed no significant difference between the two groups (t = - 0. 269 , P =0.790). In the MHC group , the lesions had complex and uneven echoes and blurred boundaries , while in the SNNL group , most lesions were in the right lobe and were hypoechoic with clear boundaries. No blood flow signals were detected on CDFI in these two groups. Both groups had circular enhancement around the lesions in arterial phase on CEUS , and the mean thickness showed a significant difference between the MHC group and the SNNL group ( 5. 00 ± 1. 69 mm vs 2. 37 ± 0. 87 mm , t = 5. 374 , P <0. 001) . In the MHC group , the area in lesions without enhancement in delayed phase was significantly larger than that in arterial phase (t = - 4. 508 , P = 0. 001 ) , while in the SNNL group , the area in lesions without enhancement showed no significant difference between delayed phase and arterial phase (t = - 0. 449 , P =0. 660 ) . Conclusion The thickness of circular enhancement in arterial phase on CEUS and the presence or absence of the enlargement in the area without enhancement contributes to the differential diagnosis of single MHC and SNNL. [ABSTRACT FROM AUTHOR]

Objective To investigate the differences between carvedilol and propranolol in the degree of hepatic venous pressure gradient (HVPG) reduction, response rate, and adverse events in patients with cirrhotic portal hypertension, and to evaluate the efficacy and safety of carvedilol in reducing portal vein pressure. Methods Sixty-four patients with cirrhotic portal hypertension who were diagnosed and treated in Shandong Provincial Hospital from October 2010 to January 2012 were selected and randomized into propranolol group (n=33) and carvedilol group (n=31). The dose of drugs was adjusted according to blood pressure and heart rate, and the course of treatment was 7 days. Measurements of HVPG and liver and renal function indices were performed before and after treatment, and the degree of HVPG reduction and response rate were compared between the two groups. The incidence of adverse events such as hypotension, ascites, and renal injury in the two groups was observed. Comparison of continuous data between the two groups was made by t test, and comparison of categorical data was made by chi-square test or Fisher′s exact. ResultsHVPG was reduced significantly in both carvedilol group and propranolol group, with degrees of (28.30±22.19)% and (12.38±24.09)%, respectively, and the reduction in the carvedilol group was significantly greater/higher/larger (t=0.223 4, P=0.032). The response rate was 56.7% (17/30) and 41.9% (13/31) in the carvedilol group and propranolol group, respectively, with no significant difference between the two groups (χ2=1.324, P=0.250). The carvedilol group had a significantly more reduction in mean arterial pressure (MAP) than the propranolol group (t=2.338, P=0.024), but the patients did not experience the adverse event of hypotension. The levels of bilirubin, serum creatinine, and urea nitrogen did not change significantly before and after treatment, and there was no tendency of ascites formation or aggravation. ConclusionThis randomized study suggests that within a short period of time, carvedilol is more effective than propranolol in reducing HVPG and has no obvious adverse effects. Carvedilol is safe and effective in the treatment of cirrhotic portal hypertension. [ABSTRACT FROM AUTHOR]

Objective To investigate the traditional Chinese herbs and core prescriptions commonly used by Professor Qian Ying in the syndrome differentiation - based treatment of primary liver cancer, and to guide clinical medication. Methods A retrospective analysis was performed for the clinical data of the patients diagnosed and treated by Professor Qian Ying. A descriptive analysis was performed to analyze Professor Qian Ying's clinical medication and prescriptions in the treatment of primary liver cancer, and the complex network and clustering with point mutual information were used to analyze the complex association between multiple traditional Chinese herbs. Results A total of 111 patients with primary liver cancer were enrolled. There were 287 visits, 287 prescriptions, and 132 traditional Chinese herbs in total. The core herbs used by Professor Qian Ying were Visci herba, raw Astragalus membranaceus, Salvia miltiorrhiza, Oldenlandia diffusa, and Polygoni Orientalis Fructus, and this result was consistent with the composition of Huqi powder developed by Professor Qian Ying. The prescriptions commonly used included Huqi powder, Shengmai decoction, and Xiaoyao powder. Conclusion Salvia miltiorrhiza is the special herb used by Professor Qian Ying in the treatment of primary liver cancer and Huqi powder developed by Professor Qian Ying is the commonly used prescription. [ABSTRACT FROM AUTHOR]

The therapeutic methods for portal hypertension have been greatly developed, including surgical operation, endoscopic injection of sclerosing agents, endoscopic variceal ligation, tissue adhesive embolization, and radioactive intervention, and have significantly reduced the fatality of portal hypertension. Focusing on the risk assessment and individualized management of portal hypertension, Baveno IV emphasizes patient stratification and individualized treatment. Based on Baveno IV consensus, this article briefly introduces hepatic venous pressure gradient and liver function reserve, as well as the application of characteristic parameters such as “gastro-renal shunt” in the development and prevention of variceal bleeding. [ABSTRACT FROM AUTHOR]