Transjugular intrahepatic portosystemic shunt combined with esophagogastric variceal embolization in the treatment of a large gastrorenal shunt

AIM: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS) combined with stomach and esophageal variceal embolization(SEVE) in cirrhotic patients with a large gastrorenal vessel shunt(GRVS).METHODS: Eighty-one cirrhotic patients with gastric variceal bleeding(GVB) associated with a GRVS were enrolled in the study and accepted TIPS combined with SEVE(TIPS + SEVE), by which portosystemic pressuregradient(PPG), biochemical, TIPS-related complications, shunt dysfunction, rebleeding, and death were evaluated. RESULTS: The PPGs before TIPS were greater than 12 mmH g in 81 patients. TIPS + SEVE treatment caused a significant decrease in PPG(from 37.97 ± 6.36 mmH g to 28.15 ± 6.52 mm Hg, t = 19.22, P < 0.001). The percentage of reduction in PPG was greater than 20%from baseline. There were no significant differences in albumin, alanine aminotransferase, aspartate aminotransferase, bilirubin, prothrombin time, or Child-Pugh score before and after operation. In all patients, rebleeding rates were 3%, 6%, 12%, 18%, and 18% at 1,3, 6, 12, and 18 mo, respectively. Five patients(6.2%)were diagnosed as having hepatic encephalopathy. The rates of shunt dysfunction were 0%, 4%, 9%, 26%,and 26%, at 1, 3, 6, 12, and 18 mo, respectively. The cumulative survival rates in 1, 3, 6, 12, and 18 mo were100%, 100%, 95%, 90%, and 90%, respectively.CONCLUSION: Our preliminary results indicated that the efficacy and safety of TIPS + SEVE were satisfactory in cirrhotic patients with GVB associated with a GRVS(GVB + GRVS).

RRM1 gene expression in peripheral blood is predictive of shorter survival in Chinese patients with advanced non-small-cell lung cancer treated by gemcitabine and platinum

Objective:To evaluate the predictive values of gene expressions of ribonucleotide reductase M1(RRM1) and breast cancer susceptibility gene 1(BRCA1) in peripheral blood from Chinese patients with non-small-cell lung cancer(NSCLC) treated with gemcitabine plus platinum.Methods:Forty Chinese patients with advanced NSCLC were recruited and received gemcitabine 1200 mg/m 2 on Days 1 and 8 plus carboplatin AUC 5 on Day 1.RRM1 and BRCA1 expression levels in peripheral blood were detected by quantitative reverse transcription-polymerase chain reaction(RT-PCR) .Kaplan-Meier survival curve and log-rank test were performed to evaluate the correlation between gene expression and overall survival for these subjects.Results:No correlation was observed between gene expression of RRM1 and that of BRCA1(P>0.05) ,but there was a strong correlation between the expression of RRM1 and the response to chemotherapy(P=0.003) .Subjects with low RRM1 expression levels in peripheral blood had longer sur-vival time than those with high RRM1 expression levels(16.95 vs.12.76 months,log-rank 3.989,P=0.046) .However,no significant association between BRCA1 expression levels and survival time was found(16.80 vs.13.77 months,log-rank 0.830,P=0.362) .Conclusions:Patients with low RRM1 expression levels in peripheral blood have a greater response to chemotherapy and longer survival time.Advanced NSCLC patients with low RRM1 expression levels may benefit from gemcitabine plus platinum therapy.RRM1 mRNA expression in peripheral blood could be used to predict the prognosis of NSCLC treated by gemcitabine and platinum.